Attitudes toward substance misusing pregnant women following a specialist education programme: An exploratory case study

Addressing stigma for families affected by opioid use disorder

Pregnant and parenting people with opioid use disorder commonly experience stigma, or the enactment of negative attitudes, beliefs, and stereotypes, during their pregnancy and at delivery. We will describe four different domains of stigma: self, interpersonal, structural, and policy, and discuss how they intersect to amplify the experiences of shame, anxiety, isolation, lack of trust for birthing people and parents that can contribute to the avoidance of prenatal care and substance use treatment which can impact pregnancy and infant health outcomes. We will review a case example where stigma contributed to poor care, review preferred person-first language to use when talking to and about families impacted by opioid use disorder, and describe emerging interventions to address and mitigate the effects of stigma in the perinatal setting.

Effect of E-learning clinical management of substance-dependent pregnant women on the knowledge and clinical skill performance of midwives: a randomized controlled trial

BACKGROUND

Drug use during pregnancy and post-partum undoubtedly significantly affects maternal and infant morbidity. Healthcare providers, especially midwives who care for pregnant and postpartum women, must possess adequate knowledge and clinical skills to manage their patients appropriately. This study aimed to determine the effect of an e-learning intervention on midwives' knowledge and clinical performance skills in caring for substance-dependent pregnant women during labor and post-partum.

METHODS

A randomized controlled trial based on e-learning was conducted in Shiraz, Iran. One hundred midwives working in governmental maternity hospitals were recruited and randomly assigned to the intervention (n = 50) or control (n = 50) group through blocked randomization. The intervention group underwent e-learning for 4 weeks on clinical considerations during labor and post-partum of substance-dependent mothers. The control group received no educational intervention from the research group. Pre-test, post-test, and one-month retention tests included a knowledge assessment questionnaire and an objective structured clinical examination test to assess clinical skill performance in both groups. The data were analyzed using SPSS 16 software at a significance level of P < .05. Analysis of variance with repeated measures was used to compare the mean data between and within the groups.

RESULTS

A total of 93 midwives with a mean age of 36.78 ± 8.06 years were recruited and randomly assigned to the control group (n = 47) and the intervention group (n = 46). Seven midwives dropped out for different reasons. Immediately after and one month after the intervention, both the level of knowledge and the level of clinical skill performance of the midwives in the intervention group increased compared to those before the intervention (P < .001) and compared to those in the control group (P < .001). The knowledge of the intervention group in the one-month retention test was significantly reduced compared to that immediately after the intervention (P < .001), but clinical skill performance in the intervention group at one month after the intervention was not significantly different from that immediately after the intervention (P = 1.00).

CONCLUSIONS

E-learning about clinical considerations during labor and post-partum in substance-dependent mothers can be an effective way to improve midwives' knowledge and clinical skill performance. Although knowledge decreased one month after training, clinical skill performance improved.

TRIAL REGISTRATION

http://www.irct.ir/ , IRCT20180928041164N1 registered November 13, 2018.

A systematic review of midwives' training needs in perinatal mental health and related interventions

Background

Midwives may be key stakeholders to improve perinatal mental healthcare (PMHC). Three systematic reviews considered midwives' educational needs in perinatal mental health (PMH) or related interventions with a focus on depression or anxiety. This systematic review aims to review: 1) midwives' educational/training needs in PMH; 2) the training programs in PMH and their effectiveness in improving PMHC.

Methods

We searched six electronic databases using a search strategy designed by a biomedical information specialist. Inclusion criteria were: (1) focus on midwives; (2) reporting on training needs in PMH, perinatal mental health problems or related conditions or training programs; (3) using quantitative, qualitative or mixed-methods design. We used the Mixed Methods Appraisal Tool for study quality.

Results

Of 4969 articles screened, 66 papers met eligibility criteria (47 on knowledge, skills or attitudes and 19 on training programs). Study quality was low to moderate in most studies. We found that midwives' understanding of their role in PMHC (e.g. finding meaning in opening discussions about PMH; perception that screening, referral and support is part of their routine clinical duties) is determinant. Training programs had positive effects on proximal outcomes (e.g. knowledge) and contrasted effects on distal outcomes (e.g. number of referrals).

Conclusions

This review generated novel insights to inform initial and continuous education curriculums on PMH (e.g. focus on midwives' understanding on their role in PMHC or content on person-centered care).

Registration details

The protocol is registered on PROSPERO (CRD42021285926).

Validity and Reliability of the Modified Attitudes About Drug Use in Pregnancy Scale

OBJECTIVE

To contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses.

DESIGN

Cross-sectional survey.

SETTING

Four hospitals in the Midwestern United States.

PARTICIPANTS

Registered nurses who worked in perinatal units (N = 440).

METHODS

We collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal-newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach's alpha. We tested for differences between units using analysis of variance and Tukey's post hoc honest significant difference test of pairwise differences.

RESULTS

The final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88-.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant.

CONCLUSIONS

The Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research.

A systematic review of stigma interventions for providers who treat patients with substance use disorders

BACKGROUND

Stigma surrounding substance use disorders (SUDs) is a frequently cited barrier to treatment engagement. Research consistently demonstrates that healthcare professionals' attitudes towards patients with addiction problems are often negative and may adversely impact service delivery. The current study presents a systematic review of stigma interventions for providers who treat patients with SUDs, in order to evaluate the quality of existing studies and potential for implementation in clinical settings.

METHODS

This systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases included PubMed, APA PsycInfo and the Cochrane Database of Systematic Reviews. Of the 1462 records identified between 2011 and 2019, 15 studies were eligible for inclusion. A narrative synthesis of stigma interventions summarized the change in stigmatizing attitudes held by providers.

RESULTS

Studies included heterogeneous and culturally diverse samples of providers (N = 1324), who varied by age, location, discipline, and experience, with the exception of primarily female providers (75%). Results delineated six types of provider stigma interventions with components including online education, in-person education, in-person contact with consumers in recovery, or some combination of these elements. The highest quality studies incorporated motivational interviewing or communication training interventions, and many interventions combined either in-person mentorship or contact with individuals in recovery. Positive effects on provider attitudes occurred at several levels of educational and consumer contact interventions. Interventions with consumer contact demonstrated long-term maintenance of attitudinal shifts. Despite significant methodological limitations and low-quality assessment ratings, several studies utilized real-world providers and patients, as well as practical, innovative, brief, and potentially cost-effective interventions, particularly in locations with limited technological resources.

CONCLUSIONS

Research on provider stigma interventions increased in recent years, indicating greater worldwide attention to the negative impact of stigma. While educational interventions alone can be helpful in attitudinal change, contact with individuals in recovery from SUDs is a vital component of provider stigma interventions, particularly for lasting effects. This review highlights the importance of including implementation outcomes, such as sustainability and cost-effectiveness, in the study of stigma interventions for providers of addiction treatment.