Longitudinal exploration of the delivery of care following a successful antenatal practice change intervention
IntroductionThis is a secondary analysis of a stepped-wedge trial. The sustainment of evidence-based care is essential for ongoing population benefits. In a randomized stepped-wedge controlled trial of public maternity services across three health sectors in New South Wales, Australia, we demonstrat...
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Frontiers Media S.A.
2025-05-01
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| author | Alix Hall Alix Hall Alix Hall Emma Doherty Emma Doherty Emma Doherty Nicole Nathan Nicole Nathan Nicole Nathan John Wiggers John Wiggers John Wiggers John Attia John Attia Belinda Tully Belinda Tully Belinda Tully Elizabeth J. Elliott Elizabeth J. Elliott Christopher Oldmeadow Christopher Oldmeadow Simon Chiu Simon Chiu Melanie Kingsland Melanie Kingsland Melanie Kingsland |
| author_facet | Alix Hall Alix Hall Alix Hall Emma Doherty Emma Doherty Emma Doherty Nicole Nathan Nicole Nathan Nicole Nathan John Wiggers John Wiggers John Wiggers John Attia John Attia Belinda Tully Belinda Tully Belinda Tully Elizabeth J. Elliott Elizabeth J. Elliott Christopher Oldmeadow Christopher Oldmeadow Simon Chiu Simon Chiu Melanie Kingsland Melanie Kingsland Melanie Kingsland |
| author_sort | Alix Hall |
| collection | DOAJ |
| description | IntroductionThis is a secondary analysis of a stepped-wedge trial. The sustainment of evidence-based care is essential for ongoing population benefits. In a randomized stepped-wedge controlled trial of public maternity services across three health sectors in New South Wales, Australia, we demonstrated a positive practice change related to addressing alcohol use during pregnancy. This change followed a 7-month implementation strategy conducted between February 2018 and November 2019. However, evidence suggests that the impact of implementation strategies may reduce over time. It is important to document when and if recommended care reduces, so that timely support for sustainment can be provided.MethodsAs a secondary analysis, an interrupted time series analysis of outcomes from the largest sector of the randomized stepped-wedge controlled trial was conducted. The analysis explored the rate, time points, and extent of change in women’s reported receipt of recommended antenatal care for alcohol consumption, following delivery of an effective implementation strategy.ResultsA total of 4,909 (82% consented) women were surveyed. The proportion of pregnant women receiving recommended care reduced significantly per week following the withdrawal of implementation support, for three of the four outcomes: assessment of alcohol consumption (% change per week: −0.66, 95% CI: −1.1, −0.26); advice not to consume alcohol during pregnancy and of potential risks (% change per week: −0.63, 95% CI: −1.1, −0.22); and complete care relevant to alcohol risk level (advice and referral) (% change per week: −0.64, 95% CI: −1.1,-0.22). Similar results were observed regardless of the timing of antenatal visits. A more rapid decline occurred for most outcomes from the end of implementation until approximately 30 weeks post-implementation.DiscussionDespite a reduction in the receipt of recommended care, rates were still higher post-implementation than pre-implementation. Receipt of recommended antenatal care for alcohol consumption declined after active implementation support was withdrawn. The findings suggest the need for ongoing monitoring of care delivery and the introduction of additional sustainability strategies at key time points post-withdrawal of implementation support. |
| format | Article |
| id | doaj-art-1eea9e2d6cee475fbb1be2aaf76f580d |
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| language | English |
| publishDate | 2025-05-01 |
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| spelling | doaj-art-1eea9e2d6cee475fbb1be2aaf76f580d2025-08-20T02:28:20ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-05-011210.3389/fmed.2025.14760831476083Longitudinal exploration of the delivery of care following a successful antenatal practice change interventionAlix Hall0Alix Hall1Alix Hall2Emma Doherty3Emma Doherty4Emma Doherty5Nicole Nathan6Nicole Nathan7Nicole Nathan8John Wiggers9John Wiggers10John Wiggers11John Attia12John Attia13Belinda Tully14Belinda Tully15Belinda Tully16Elizabeth J. Elliott17Elizabeth J. Elliott18Christopher Oldmeadow19Christopher Oldmeadow20Simon Chiu21Simon Chiu22Melanie Kingsland23Melanie Kingsland24Melanie Kingsland25School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaHunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaHunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaHunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaHunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaHunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, AustraliaDiscipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaSydney Children's Hospital Network, Kids Research, Sydney, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaHunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, AustraliaIntroductionThis is a secondary analysis of a stepped-wedge trial. The sustainment of evidence-based care is essential for ongoing population benefits. In a randomized stepped-wedge controlled trial of public maternity services across three health sectors in New South Wales, Australia, we demonstrated a positive practice change related to addressing alcohol use during pregnancy. This change followed a 7-month implementation strategy conducted between February 2018 and November 2019. However, evidence suggests that the impact of implementation strategies may reduce over time. It is important to document when and if recommended care reduces, so that timely support for sustainment can be provided.MethodsAs a secondary analysis, an interrupted time series analysis of outcomes from the largest sector of the randomized stepped-wedge controlled trial was conducted. The analysis explored the rate, time points, and extent of change in women’s reported receipt of recommended antenatal care for alcohol consumption, following delivery of an effective implementation strategy.ResultsA total of 4,909 (82% consented) women were surveyed. The proportion of pregnant women receiving recommended care reduced significantly per week following the withdrawal of implementation support, for three of the four outcomes: assessment of alcohol consumption (% change per week: −0.66, 95% CI: −1.1, −0.26); advice not to consume alcohol during pregnancy and of potential risks (% change per week: −0.63, 95% CI: −1.1, −0.22); and complete care relevant to alcohol risk level (advice and referral) (% change per week: −0.64, 95% CI: −1.1,-0.22). Similar results were observed regardless of the timing of antenatal visits. A more rapid decline occurred for most outcomes from the end of implementation until approximately 30 weeks post-implementation.DiscussionDespite a reduction in the receipt of recommended care, rates were still higher post-implementation than pre-implementation. Receipt of recommended antenatal care for alcohol consumption declined after active implementation support was withdrawn. The findings suggest the need for ongoing monitoring of care delivery and the introduction of additional sustainability strategies at key time points post-withdrawal of implementation support.https://www.frontiersin.org/articles/10.3389/fmed.2025.1476083/fullsustainmentsustainabilityinterrupted time seriessegmented regressionimplementation |
| spellingShingle | Alix Hall Alix Hall Alix Hall Emma Doherty Emma Doherty Emma Doherty Nicole Nathan Nicole Nathan Nicole Nathan John Wiggers John Wiggers John Wiggers John Attia John Attia Belinda Tully Belinda Tully Belinda Tully Elizabeth J. Elliott Elizabeth J. Elliott Christopher Oldmeadow Christopher Oldmeadow Simon Chiu Simon Chiu Melanie Kingsland Melanie Kingsland Melanie Kingsland Longitudinal exploration of the delivery of care following a successful antenatal practice change intervention Frontiers in Medicine sustainment sustainability interrupted time series segmented regression implementation |
| title | Longitudinal exploration of the delivery of care following a successful antenatal practice change intervention |
| title_full | Longitudinal exploration of the delivery of care following a successful antenatal practice change intervention |
| title_fullStr | Longitudinal exploration of the delivery of care following a successful antenatal practice change intervention |
| title_full_unstemmed | Longitudinal exploration of the delivery of care following a successful antenatal practice change intervention |
| title_short | Longitudinal exploration of the delivery of care following a successful antenatal practice change intervention |
| title_sort | longitudinal exploration of the delivery of care following a successful antenatal practice change intervention |
| topic | sustainment sustainability interrupted time series segmented regression implementation |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1476083/full |
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