Reducing Alcohol Consumption Review

Reducing Alcohol Consumption among Pregnant and Planning Pregnant Women Literature Review on Interventions

Name

Institution

Date

Abstract

The research project majored on investigating interventions in reducing alcohol consumption among pregnant and women planning to get pregnant. The main methodology of systematic literature review search. The sources 9 years old were effective in addressing the research questions and the objectives of the study. The inclusion and exclusion criteria were used to access the most credible sources. The research objectives aimed at examining the interventions in reducing alcohol consumption. The main interventions established were multimedia and education approach, psychological education approaches, and the behavioural change construct approaches. The study also investigated the challenges and the barriers facing on addressing the interventions. Thereafter a discussion and a conclusion are provided together with recommendations on the course of action.

Reducing Alcohol Consumption among Pregnant and Planning Pregnant Women Literature Review on Interventions

1.1Background

There is no safety in drinking alcohol during or wanting to become pregnant. Studies have shown that all bears and wines pose a potential risk to the developing fetus and the mother. The umbilical cord connects the baby to the mother (Centers for Disease Control and Prevention, 2018). Therefore, alcohol is easily passed from the mother to the features leading to serious problems both to the mother and the fetus. The most prevalent cases on alcohol consumption during pregnancy point on the fetus. Three months before getting pregnant can also lead to baby abnormalities. As a result, the American Academy of Pediatricians, American College of Obstetricians and Gynecologists, and the U.S Surgeon General, and the CDC confirm that taking alcohol during pregnancy can potentially lead to threatening conditions on the fetus development and growth.

Alcohol consumption can lead to harm of pregnant women or closely related individuals. Research has shown that consuming alcohol during or before falling pregnant can result in organs or Pain damage of the fetus or the emPyo. In addition, consuming alcohol during pregnancy has led to increased cases of low birth weight, intrauterine growth retardation, premature birth, spontaneous abortion, and stillbirth. The most prevalent and disabling risk is fetal alcohol syndrome (FAS) (Centers for Disease Control and Prevention, 2018). The condition can be more severe leading to fetal alcohol spectrum disorder (FASD). Children born with FAS condition are predisposed to adaptive, emotional, behavioural, and cognitive deficits. In addition, they suffer from dysmorphic facial features, postnatal and prenatal growth restriction, congenital anomalies, and permanent Pain damage. In fact, such individuals present high cases of behavioural and mental disorders at 18, chromosomal abnormalities at 43, deformities, and congenital malformations. Individuals born with FAS highly suffer from comorbid conditions such as behavioural, mental, cognitive developmental, visual, auditory, and language problems (Centers for Disease Control and Prevention, 2018). The neurodevelopmental problems originating from FAS potentially increases the risk of secondary disabilities characterized by lack of capacity to maintain employment, inability to lead an independent life, frequent contact with law enforcement, mental health problems, substance abuse, and academic failure.

It is a subject that is always on discussion since some medics recommend that it is okay to drink moderately or lightly. In fact, according to research published in the Journal of Epidemiology and Community health in 2010 pointed out that moderate drinking cannot lead to any harm. The study was investigated a case study on five years old babies born of mothers that consumed occasionally or twice per week. The research observed that the children cognitive and behavioural aspect was not compromised. However, the researchers confirmed the need to observe the children for any developmental challenges during their childhood. The Department of Health (2019) pointed out that it is safe not to engage in alcohol consumption while Peastfeeding, pregnancy and when planning to become pregnant. Department of Health (2019) further argued that there is no safe drinking even on the slightest level since the more the consumption the greater the harm to the child. Department of Health (2019) providers pre-pregnancy alcohol consumption to affect the fertility rates of women and men. In addition, it highly influences to problems of the unborn child. When pregnant according to the Department of Health (2019) alcohol consumption can lead to reduced birth weights, miscarriage, stillbirth, premature birth, birth defects, and other range of conditions described under the fetal alcohol spectrum disorder. The report presented by the Department of Health (2019) concluded that alcohol consumption while Peastfeeding is transferred to the mother milk leading to a reduction in flow, negative impact on the spinal cord and also damage to the Pain.

In this respect, the topic of alcohol consumption before and during pregnancy is very important in addressing associated issues in public health. The research has indicated that consuming alcohol leads to delivery problems as well as a defect on the fetus. The study is important in increasing more awareness in regard to NHMRC and also on factors associated with alcohol abuse. In addition, the study is developed to address limited screening for the alcohol amount in the blood during and before pregnancy.

1.2 Objectives and Aims of the Study

The study is aimed at examining the effectiveness of the interventions targeted on reducing alcohol consumption before and during pregnancy.

Objectives

To identify the existing intervention programs

To evaluate the efficacy of intervention programs

What are the main barriers or challenges of intervention program

Recommendations for improvement of the effectiveness of the intervention programming reducing the alcohol consumption in pregnant women.

1.3Research QuestionsIn order to complete the project, the following questions will be identified and used to attain

The research objectives

1) What are existing interventions in helping pregnant women in achieving abstinence from alcohol

2) How efficient are the interventions programs in reducing alcohol consumption among pregnant and planning pregnant women

3) What are the main barriers and challenges in implementing the intervention programs and how to overcome the barriers

1.4 Research Design

The systematic literature review was conducted using a combination of the cohort, case studies and randomized trials. The combination of the longitudinal studies was deemed effective at analysing the intervention that reduces alcohol consumption among pregnant women or those intending to get pregnant. The cohort studies selected were composed of women that were pregnant and were exposed to alcohol consumption. In the case studies, the examination majored on the individuals showing the signs of alcohol exposure during pregnancy. The aim was to help the women overcome the situation. The cohort studies sampled were either prospective or retrospective. Most of the studies were sampled and examined over a period of time. The case studies and cohort studies were examined in the mixture of the developed and the developing nations intending at analysing how social economic factor can influence alcohol consumption during pregnancy. Randomized trials and controlled trials were used where the women were examined after and before interventions. In some studies a control and a test group were used to test the significance of the interventions. It seems there is a balance between the case studies and the cohort studies approach.

2.0 Methodology

The methodology used in the research is referred to a systematic literature review. It means conducting a critical appraisal of the clearly selected and identified research aiming at responding to the research question (Dewey amp Drahota, 2016). A Pief history of systematic literature review argues its origin on the medical field linked to the concept of the evidence-based research (Dewey amp Drahota, 2016). The concepts and the context that led to the use of systematic literature review during research resulted from the demand for the evidence-based practice (Gough, 2012). The comparison is also based on the identified research weaknesses and strengths during the review. In addition, Gough (2012) argue that evidence based research led to the demand for systematic literature review in the medical field but it is currently applied to the science and the management field.The following systematic review was carried out using research report that focused on cohort and case studies targeting interventions to reduce alcohol consumption among the pregnant women and those targeting to become pregnant. The searches was conducted using the following databases Medline, Embase, Cinahl, Eric, Psych Articles, Psych Info, Wiley LiPary, NCBN (PubMed). Screening of sourced published in the last 9 years was efficient in establishing interventions that have been applied in the reduction of alcohol consumption among the pregnant and those planning for their pregnancy. The aim was to achieve the articles and publications that provided information on the public health intervention mechanism such as educational campaigns and health promotion activities. Data was assessed for quality through research questions and below mentioned criterion.

2.1Exclusion and Inclusion Criteria

In this respect, inclusion and exclusion criteria were used to identify the most relevant materials. The inclusion criteria covered the materials that contained efficient information on the intervention of reducing alcohol consumption when planning or during pregnancy. The exclusion criteria included articles and publications that not covered the scope developed in the search results and those that published in other languages, editorials or reviews of other articles.

2.2 Sampling Procedure

The objective of the study was to investigate the interventions on reducing the alcohol consumption on pregnant and those intending to get pregnant. The following were results for the literature search

The selected searches majored on the behavioural intervention construct, psychological and counselling interventions, and education and media intervention.

2.3 Limitations of the Study

The following systematic review was limited to studies conducted about interventions in reducing alcohol consumption among the pregnant women and those that intending to become pregnant. It was not easy to combine the studies leading to the research question. The process was long and tedious. The length of the studies, the number of participants and the country examined was not well indicated and made it difficult in comparing the interventions. Some of the journal articles could be biased by the publisher editing details. The studies were limited the uncertainties of the systematic reviews compiled by some of the authors. In addition, such studies lack a universal standards indicating challenging relating to conflicts of interests and author bias.

3.0 Results

The following results are presented from the systematic literature review on the interventions used in reducing alcohol consumption among the pregnant women, Peastfeeding mothers and those intending to get pregnant. The information was obtained by carefully checking at the headings, the introduction, and statement of the problem, the methodology, findings and conclusion.

3.1Publications targeting on, multimedia, psychological, behaviour change and education interventions and their efficiency

Key Themes Author

Multimedia and Education Interventions Paula Gebara et al. (2013) CrawfordWilliams, et al (2015) Hanson, Winberg amp Elliott (2012) Fetal Alcohol Spectrum Disorder (2019) Tzilos, Sokol amp Ondersma (2011) Leppo, Hecksher amp Tryggvesson (2014)

Psychological Counselling Intervention Van der Wulp (2014) van der Wulp, Hoving amp de Vries (2013) McPide, Carruthers amp Hutchinson (2012). Fetal Alcohol Spectrum Disorder (2019) Comasco et al (2012) Yen et al,( 2012)

Behaviour Change Constructs Interventions von Sternberg (2018) Velasquez (2017) Jonas et al (2012) von Sternberg, DiClemente amp Velasquez, (2018) Osterman (2011) Bazzo et al. (2015) Hammer amp Inglin (2014).

3.2 Barriers and challenges of interventions on reducing alcohol consumption among pregnant women and those planning for pregnancy

Key Theme Author

Barriers and challenges of intervention on reducing alcohol consumption among pregnant women Holden et al (2012) Fletcher et al (2018) Hammer amp Inglin (2014) Bazzo et al. (2015).

The compiled table for analysis of the study conducted

Author year sample size Setting methods Title

CrawfordWilliams, et al 2015 7 Australia cohort critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women

Paula Gebara et al 2013 30 n/a cohort Pief intervention and decrease of alcohol consumption among women a

Velasquez 2017 12 United States case study Preventing alcohol and tobacco exposed pregnancies CHOICES plus in

Fatal Alcohol Spectrum Disorder 2019 0 Canada case study Effective Strategies to Prevent Alcohol use in

Yen et al 2012 806 Eastern Taiwan cohort Alcohol consumption after the recognition of pregnancy among the indigenous pregnant women in Taiwan

Tzilos, Sokol amp Ondersma 2011 50 n/a Randomized trials A Randomized Phase I Trial of a Pief

Leppo, Hecksher amp Tryggvesson 2014 5 Nordic, Sweden, Norway, Finland, and Denmark cohort Why take chances Advice on alcohol intake to pregnant and non-pregnant women in four Nordic countries

Van der Wulp, Hoving amp de Vries 2013 25 Netherlands cohort A qualitative investigation of alcohol use advice during pregnancy Experiences of Dutch midwives, pregnant women and

Carruthers amp Hutchinson 2012 144 Western Australia case study Reducing alcohol use during pregnancy listening to women who drink as an intervention starting point

Van der Wulp et al 2014 142 n/a Randomized trials Reducing alcohol use during pregnancy via health counselling by midwives and internet-based computer tailored feedback

Comasco et al 2012 2264 Sweden cohort Alcohol consumption among pregnant women in the Swedish Sample and its effects on new born outcome

Von Sternberg, DiClemente amp Velasquez 2018 540 n/a Randomized trials Profiles of behaviour change construct for reducing alcohol use in women at risk of an alcohol-exposed pregnancy

Osterman 2011 15 n/a Randomized trials Feasibility of Using Motivational Interviewing to Decrease Alcohol consumption during pregnancy

Hammer amp Inglin 2014 50 n/a cohort Evaluation of a Multilevel and Integrated Program to Raise Awareness of the Harmful Effects of prenatal alcohol exposure in

Bazzo et al 2015 0 switzerland Randomized trials I dont think its risky, but pregnant womens risk perceptions of maternal drinking and smoking

to Holden et al 2012 0 n/a Randomized trials Depressive symptoms ,substance abuse and intimate partner violence among the women of ethnic communities

Fletcher et al 2018 200 South Africa Randomized trials Attitudes toward alcohol use during pregnancy among women recruited from alcohol-serving venues in Cape Town, South Africa

Howlett et al 2019 0 online case study A Survey of Heath Care Professional knowledge and experience of Foetal Alcohol spectrum disorder and alcohol use during pregnancy

Misir amp Paarlberg 2017 0 n/a case study A Pregnant Woman Who Could Not Stop Drinking Management of Alcohol Abuse during pregnancy

3.1.1 Multimedia and Education Interventions

Multimedia and education interventions are among the leading interventions in addressing alcohol consumption during pregnancy or in preparation to get pregnant. CrawfordWilliams, et al (2015) investigated the health interventions targeting pregnant women and alcohol consumption. The authors applied a systematic literature search. Just like in this particular study the main key search employed in public health studies, interventions, alcohol, and pregnancy. The inclusion criteria included interventions on alcohol consumption by pregnant women and the knowledge impacted. The aim and the objectives were not very distant to the objectives of this particular research. A sample size of seven studies was included that majored on educational and multimedia interventions. The six out of seven studies showed remarkable improvement in impacting knowledge against alcohol consumption during or when planning for pregnancy. One study significantly contradicted the results. However, four out of seven studies investigated based on the rate of consuming alcohol among pregnant women where the implications were insignificant. Basing on the research sentiments, it is not impactful to measure alcohol consumption interventions basing on the rate of drinking. The author proposed a further study based on the evidence approach.

The search identified another study that was significant in proposing interventions against alcohol consumption on women. The study by Paula Gebara et al. (2013) identified that intervention on alcohol consumption is a priority issue since it not only compromise the health of the developing fetus but also of the women. The study intervention is known as a Pief intervention which significantly improved the results on preventing alcohol consumption among women and specifically the pregnant and the nursing mothers. The study was conducted using a systematic literature review where data from scientific publications were investigated. In addition, the study included some of the databases that are relevant in this particular study. 133 publications were identified and central theme collated with the aim of this particular research. Content analysis technique was useful in reviewing the texts in the research. Pief intervention technique was impacting in changing the behaviour among the young women and pregnant women. It entailed the use of telephone, computers and face-to-face applications. The Pief intervention technique followed on the number of doses and alcohol consumption.

More on education-related intervention it is important to investigate the work presented by Velasquez (2017). The author based the study basing on the case study of United States based pregnant women. The study recognized the significant risks that arise to the consumption of alcohol during pregnancy. Therefore, CHOICES Plus is an evidence-based approach used in this study. The intervention is based on preconception. The study design was based on the Pief Advice and CHOICES Plus. A sample size of 12 was examined. The women were subjected to referral services, Pief Advice, and contraceptive visit. Basing on a 9 months examination the primary result was reduced risks from alcohol consumption. CHOICES Plus an education-based intervention significantly reduced the risk of alcohol-related consequences.

In respect to education intervention strategies, the Fatal Alcohol Spectrum Disorder (2019) developed prevention strategies that ensured complete eradication of Fetal Alcohol Spectrum Disorder. The initial level of interventional was through raising awareness. The Canadian government recognized the importance of creating awareness of the causes and the prevention strategies in the attempt to control the situation. The creating awareness campaign was concentrated on the more at risk and also the entire Canadian population. It is an intervention agenda whose effectiveness is accomplished through the combination of the specialist prenatal support care. It entails providing pregnant mothers with support services that are accessible and cultural accept in the recovery of problems relating to alcohol consumption. The services are extended to the women in the childbearing Packet. The evidence-based program concentrated more on additional programs and their information among the childbearing women and also the pregnant women in the Canadian state. The education support is carried out in the postpartum support through providing assistance by initiating and maintaining changes to the social and the health networks. Another important strategy is instituted by ensuring the policy on alcohol prevention during consumption and also among the women in their childbearing age is prevented. The evidence-based strategies are applied with the potential of reducing social and health harm relating to alcohol consumption. The policies are important since the limit the availability of alcohol and the facing that increase the decisions to consume.

Another important research was conducted on the indigenous women before and after continuing for pregnancy (Yen et al, 2012). A sample size of about 806 women was sampled in 10 hospitals. Among the information examined was the history of pregnancy, history of physical abuse, psychological health status, demographic characteristics, and substance abuse information. It was paramount to calculate the rate of alcohol consumption after recognizing pregnancy and continuity to the end of pregnancy. A logistic regression analysis was helpful in establishing the relationship between the factors. The study observed 52.5 of the women drank alcohol before confirmation of pregnancy and the 26.6 cut on the alcohol consumption after the pregnancy confirmation test. Therefore, the study identified that the early detection of pregnancy could cut on alcohol consumption by half. Therefore, the efficient intervention in this study was advocating for early intervention for the women planning to get pregnant or those suspecting pregnancy.

Further, on the risk aspect of drinking alcohol and pregnant women Tzilos, Sokol amp Ondersma (2011) investigated the use Pief and screening intervention approach. The study examined the workability of the approach following a computer-delivered Pief intervention. A sample size of 50 pregnant women was examined and a daily screening routine was conducted for every prenatal visit. The results identified Pief intervention and screening significantly reduced alcohol consumption and increased birth weight were identified. To conclude the computer-delivered Pief intervention was significant in reducing alcohol consumption during pregnancy.

Leppo, Hecksher amp Tryggvesson (2014) examined the risk management strategy employed by different jurisdiction in an attempt to prevent alcohol intake during pregnancy. The authors observed that the nature of communication on the dangers of consuming alcohol during pregnancy was communicated as a precautionary action rather than an evidence-based approach is safeguarding the life of the fetus and the mother. A sample of data collected from the Nordic, Sweden, Norway, Finland, and Denmark states showed that the harm caused by consuming alcohol during pregnancy is well communicated to the women but engulfed in the cultural and social dimension and hence diluting the medical aspect of the information. The authors recommend an evidence-based approach in the attempt to control alcohol consumption during pregnancy.

3.1.2 Psychology and Counselling Interventions

Another important theme identified the materials investigated is the psychology and Counseling Interventions. Van der Wulp, Hoving amp de Vries (2013) indulged in a study to investigate the information passed to the Dutch pregnant women and their partners and the information provided by the midwives regarding alcohol consumption during pregnancy. The authors embarked on a qualitative study where focused group discussion and a semi-structured interview with the midwives. The main model applied to increase the efficiency of the qualitative findings was the I-Change Model. Study 2 was conducted in the Netherlands southern and central regions while study 1 covered on a nation-wide study. The sample size consisted of nine partners, 25 pregnant women and 10 midwives. The author observed that midwives insisted on complete abstinence for women who insisted on consuming alcohol during pregnancy. The midwives reported that pregnant women in Dutch lacked enough information and knowledge on the dangers of consuming alcohol during pregnancy. Moreover, midwives observed that screening skills were not sufficient and properly conducted in ensuring intervention was achieved. In the second study, the views presented by the partners and the pregnant women were consistent. Midwives were considered central in disseminating information about alcohol consumption during pregnancy and their repercussions on the fetus and the partners. There were indications where women cited they received conflicting information regarding the consumption of alcohol during pregnancy.

There is widespread documentation of the dangers of consuming alcohol during pregnancy to the growing fetus. Another study conducted by Carruthers amp Hutchinson (2012) investigated the factors causing consumption of alcohol during pregnancy and how to prevent them. The authors explored the descriptive and explorative study to discuss factors that lead women to consume alcohol during pregnancy. The authors also assessed the intervention available in the form of strategies, methods and points. Study passed through ethical approval by several committees before its publications. A sample size of 144 individuals was used in the survey. The study period lasted for about one year. The survey based on self-evaluation was passed to the women attending their antenatal services in different public hospitals located in Western Australia. The survey examined case studies using social learning theory. It helped in linking self-efficacy, experiences, observational learning, individual-oriented concepts and individual behaviour. The findings were tested through the application of the Shapiro-Wik W test. It examined the independent variables against the dependent variables. The Kruskal-Wallis H non-parametric test was also applied in the case studies. The study identified that evidence-based programs and interventions that focused on regulations, laws and other intervention is more impactful in reducing alcohol consumption among pregnant women and those intending to get pregnant.

Children face neurobehavioral problems associated with their mothers consuming alcohol during pregnancy. Van der Wulp (2014) embarked on a study to investigate the interventions through tailored computer feedback and counselling by the midwives. The objective aimed at investigating the impact of computer-tailored and health counselling interventions. The study investigated a sample size of 60 midwives, 142 care respondents, 11u computer tailoring, and the 135 recruited health counselling. The results were analyzed through multilevel multiple logistic regression. The result indicated that respondents examined through the computer-based intervention stopped alcohol consumption at a faster rate compared to the women under the normal case examination. The baseline survey was conducted for a period of 6 months. Generally, pregnant women who received intervention through the computer-tailored education and counselling program were capable of stopping the consumption earlier as compared to other cases. The researcher concluded that computer-tailored intervention was more impactful in reducing alcohol consumption since the process provided space for anonymity.

Counselling and other interventions are important to the Canadian government. More information contained on the Fatal Alcohol Spectrum Disorder (2019) argue that Pief counselling intervention strategy is said to work better for the women and the girls in their childbearing age. The counselling services targeted on the women and availability of support networks on alcohol use. It is a universal strategy that is said to be more impactful and relevant in reducing alcohol consumption among pregnant women. The counselling services are provided by developing a poster that encourages screening and the other support services. Generally, the interventions carried out by the Canadian government ensure universal screening is possible for pregnant women. The other intervention ensures that the health care providers are well trained on the information on the dangers of alcohol consumption during pregnancy. Moreover, the government advocate for intervention that includes motivational interviewing, the nonjudgmental respectful approach, and women centred approach and the reducing harm for the clients that insist on alcohol consumption during pregnancy. The Canadian health docket also proves interventions that regard the importance of adhering to the Social Determinant of health. In addition, the recognition of the fact that mental health, trauma and addition are interconnectedness and individuals require support to overcome. It also means that collaboration between services is important, immediate support for addiction and alcohol use, the addiction services are sufficient for the parenting and the pregnant mothers, behavioural change mechanisms are advocated for that reduce the incidence of alcohol consumption during pregnancy. Finally, the informed approach to FASD targeting pregnant women is an excellent approach to women health.

In a quest to test the amount of alcohol that affects the neuropsychological states in a child, Comasco et al (2012) investigated the data on the maternal alcohol consumption, the birth outcomes, the maternal alcohol use and the demographic variables. The sample data was sourced from the Swedish antenatal clinic comprising of 2264 women. Self-evaluation report was keen to check on the pre and after pregnancy symptoms. The nicotine use and the Alcohol Use Disorders Identification Test were deemed effective. A phosphatidylethanol sample in blood, carbohydrate-deficient transferrin in serum and the Specific alcohol biomarkers were used. The study observed that frequent to occasional binge drinking was observed in around 49, 89 said they consumed alcohol on a regular basis. Therefore, a prenatal alcohol exposure assessment was proposed as an early intervention method that also significantly reduced the incidence of consumption for the rest of the pregnancy life. In addition, continuous assessment is important in providing possible influenced which can be managed and reduce the rate of consumption before, during and after pregnancy.

3.1.3 Behaviour Change Constraints Interventions

Von Sternberg, DiClemente amp Velasquez, (2018) examined data sourced from the project CHOICES. The aim was to examine the mechanism of reducing alcohol exposure on pregnancy women. The methodology utilized the randomized controlled trial. A Trans theoretical Model of Change (TTM) construct was examined. A sample size of 540 was included in the study. It composed of women at risk of alcohol-related exposure. The study observed that under the three months post-intake the pregnant women construct recorded more behavioural and experimental change process. The main construct that necessitated the need for behavioural change was associated with the temptation to drink, confidence to reduce drinking, and the temptation of the cases to drink above average. The interventions targeting behavioural change were more impactful and successful. It was advised that the clinicians are better at ensuring change is promoted in terms of self-efficacy, decisional balance, and the process used.

Osterman (2011) investigated intervention on decreasing the rate of alcohol consumption among pregnant women. The motivational interviewing intervention was proposed. It helped in advocating for theory in behaviour change such as autonomous motivation, and psychological need satisfaction. The feasibility of the intervention was proved through a pilot study conducted on a group of 15 women. A questionnaire research tool was effective in discussing data. The preliminary research result indicated that autonomous motivation was important in increasing intervention on reducing alcohol consumption among pregnant women. In fact, theory-driven autonomous motivation was more significantly and experiential in ensuring pregnant women and those intending to become pregnant were not engaging in alcohol consumption. Randomized clinical trials were proposed as an effective method of ensuring intervention was successfully achieved.

Bazzo et al. (2015) embarked on a study to investigate a multilevel approach to raising awareness in an attempt to prevent prenatal exposure to alcohol. The action-based research was conducted among the childbearing women, the pregnant women, the campaign organization targeting maternal women and the health care professionals. The study was initiated in 2008 and another comparative study was conducted in 2013. Semi-structured questionnaires were applied to the source for the information. The opinions and awareness of the dangers of alcohol consumption during pregnancy were investigated. The intervention carried out through health professionals was more experimental in reducing alcohol consumption. The midwives and the physicians significantly advocated for abstinence. The factors formed a multilevel approach which was significantly impactful in improving attitudes and increasing awareness on the dangers of consuming alcohol during pregnancy.

Hammer amp Inglin (2014) introduces a zero-tolerance policy practised in Switzerland. It is intended for helping pregnant women to completely refrain from consuming tobacco and alcohol during pregnancy. According to the authors, the epidemiological study showed the tendency of women refuting the advice and continuing to consume alcohol and tobacco during pregnancy. The findings indicated that women have not yet accepted the risk alcohol and tobacco can extend to the unborn child. Hammer amp Inglin (2014) study investigated a sample size of 50 women that are white, educated and has partners in Switzerland. The qualitative data employed semi-structured interviews intended at drawing information on how women changed before and during pregnancy in response to alcohol consumption. The study realized that women contextualized the risk of alcohol and tobacco carried to the newborn from a completely different perspective. Therefore zero tolerance policy was more impactful as a method of refuting moral and cultural practices that seem to legitimize consumption of alcohol based on personal judgment or other issues in the society.

3.1.5 Evaluating the efficacy of the research interventions

Reducing alcohol consumption among the pregnant women (independent variable) 20 interventions

Success/fail rate

Education and multimedia 61

Psychological counselling 52

Behaviour construct interventions22

Education and Multimedia Psychological Counselling Behavioural construct

Success 6 5 2

Fail 1 2 1

The results observed that the education and multimedia plus the psychological counselling were more efficacious interventions in reducing alcohol consumption during and when planning for pregnancy. The behavioural construct were least efficacious interventions within the studies conducted.

3.1.4 Barriers and Challenges of the interventions

Most women undergo emotional and psychosocial challenges during pregnancies. The situation can be stressful predisposing pregnant women in risky behaviour. According to Holden et al (2012) conducted a study to investigate the intimate partner violence, substance abuse and depressive symptoms and their influence on the pregnant women consumption of alcohol. A recruitment program was developed targeting the physicians, clinics, and local hospitals in the local communities, schools, department of family and children services and the Richmond County Health Department. The following test procedures were used the Edinburgh postnatal depression scale. The tool was used to test depression for postpartum and pregnant women. A screening tool was also used to test for the women going through abuse period during and post pregnancy period. In addition, a drug and alcohol use test was also conducted to test the frequency of consumption. Statistical package for social science software was used to measure the relationships and descriptive statistics. The Pearson regression and correlation coefficient was established. The study identified behavioural and psychological health issues among the sampled women. Factors identified as barriers to seeking help and opting for alcohol and substance abuse were expenses associated with seeking help, lack of resources, inexperienced caregivers, fear of negative impact, unsatisfactory contacts, cultural attitudes and gender role socialization.

In addition, Fletcher et al (2018) embarked on a mixed-method study to investigate attitudes that lead pregnant women to consume alcohol during or after giving birth. The study concentrated on the areas of South Africa, and Cape Town. The study was motivated by the fact that Cape Town is highly proliferated with high rates of fetal alcohol spectrum disorder. The authors argued that attitude change among women can be more impactful in changing the behaviour. A sample size of 200 women was examined in the study. Both qualitative and quantitative data was helpful. The logistic regression models were used in predicting the behaviours that lead to barrier creation and increasing attitude of alcohol consumption during pregnancy. Qualitative analyses revealed that main barriers are feelings of invincibility, reliance on the venue for support, drinking because of stress, and unplanned pregnancy. The authors proposed structural support coupled with intrinsic motivation as the main strategies to overcome barriers to eradication of alcohol consumption during pregnancy.

Studies have it that Foetal Alcohol Spectrum Disorders can be prevented to stop children from inheriting congenital abnormalities and developmental disability. As discussed by Howlett et al (2019) that screening is important in the early detection to prevent the conditions been passed to the growing foetus. The study embarked on an online survey targeting health professionals such as general practitioners, paediatricians, obstetricians, health visitors and the midwives. The test was to evaluate the clinical practices, attitudes, and perceived knowledge toward prevention of alcohol consumption among pregnant women. It was observed that lack of awareness and screening services were important barriers that prevented addressing alcohol consumption among pregnant women and those planning to get pregnant.

It is known that alcohol consumption significantly harms the health of the growing foetus. A study conducted by Misir amp Paarlberg (2017) examined reasons why pregnant women were not capable of stopping drinking. The authors suppose that alcohol addiction among pregnant mothers does not hurt the child only but also the partners, the process of transitioning to motherhood and the social environment.

4.0 Discussion

Misusing alcohol is a public health problem facing many people in the world. The issues range from the social, psychological and the physical problems affecting the community, the family and the individuals. From the above studies it is noted that consuming alcohol when planning or during pregnancy increases the risk of giving birth to a child with developmental disabilities and defects. Fetal alcohol spectrum disorder (FASDs) is one of the recognized consequences of consuming alcohol during pregnancy. It means the fetal exhibits learning, behavioural, mental, and physical disabilities. It is also regarded as the most severe repercussion of consuming alcohol during pregnancy. Children suffering from the FASDs exhibit neurodevelopmental problems, growth deficits, and facial malformations.

4.1 Education and Multimedia Intervention

One of the interventions described in the gathered literature is alcohol screening. The primary caregivers have the responsibility to screen the women in their reproductive age at a regular basis testing those at risk for alcohol abuse disorders and excessive alcohol use. Screening is followed by a Pief intervention that guards the practitioners in the quest to treat the women of the possible occurrence of FASDs disorders. In fact, screening is the initiation intervention since it helps in determining the severity of the condition and advocating for the treatment method which more impactful (Young et al, 2018). An appropriate tool should be administered during the screening process and the risks index determined must be discussed with the pregnant women or women expecting to get pregnant (Young et al, 2018). A past history of alcohol consumption can be predictive of how often women drink alcohol during their pregnancy period. Thus it is advisable to screen the women in their productive age at an early stage so as to gauge of the number of chemicals consumed before and how they can be eliminated to stop any harmful materials passed to the forming fetus (Young et al, 2018).

Media and education interventions are discussed in an attempt to reduce the amount of alcohol consumed before and during and after pregnancy (CrawfordWilliams, et al, 2015). The results showed that media health campaigns are very instrumental in helping individual change in term of beliefs, attitudes and knowledge. The studies showed that at least half of the campaign can significantly reduce consumption by controlling the individuals attitudes and beliefs towards alcohol consumption (CrawfordWilliams, et al, 2015). The finding further resulted that appropriate use of media increasing the intensities, durations and strategies is more impactful in reaching the target audiences. Most specifically, campaigns should be targeted at increasing knowledge among the most at risk group. In fact, mass media have the process and disseminate valuable information which can be significant in increasing knowledge on reducing alcohol consumption during pregnancy. The authors that major in media and education intervention reported increased need to seek treatment and information about alcohol consumption on the pregnant women at those intending to get pregnant (CrawfordWilliams, et al, 2015). The heavy drinkers easily provide their information over the media and express interest in wanting treatment and advice. It was reported that individuals are capable of expressing their worries and ideas and status over the media as opposed in face to face interactions (Leppo, Hecksher amp Tryggvesson, 2014). Such individuals fear been judged or harshness from the practitioners. However, media and education services are not significant in changing behaviour. The studies have should that behaviour change can be approached from another different perspective (Leppo, Hecksher amp Tryggvesson, 2014). Nevertheless, social media is imperative in supporting the ideas of the campaign through imparting knowledge and understanding aiming at changing attitudes and beliefs (Leppo, Hecksher amp Tryggvesson, 2014).

To investigate further on the effectiveness of the media and education strategies in addressing our research question. It is important to examine the advantages and disadvantages of the process. According to Smith, amp Denali (2014) argued that public health target the health development within the main core functions described as the assurance, policy development and the assessment. The authors argue that public health is more concerned with the outreach, policy development and information gathering. Public health initiatives are programmed to reduce the disparities existing within the communities. Therefore, it is important to impact the hard-to-reach populations. Social media is now important in reaching out to the populations that cannot be easily reached through providing a support system, creation of evidence-based policies, the assessment and the sharing of the information (Smith, amp Denali, 2014). Well-targeted and developed information can easily reach the target group due to the proliferation of mobile devices and internet services. It is faster to deliver information via the mobile phone and target the population for cost-effectiveness. The social media and education campaigns provide the public health to view the flow of information and gather information on the possible gaps and strategies needed to be improved in addressing many health concerns (Smith, amp Denali, 2014). It is therefore correct to conclude that education and media intervention strategies are effective in reaching the pregnant women and those intending to get pregnant aiming at reducing alcohol consumption before, during and after pregnancy (Smith, amp Denali, 2014).

4.3 Psychological Counselling Interventions

Another important intervention that was studied and investigated in this research is the psychological counselling services in the attempt to reduce alcohol consumption during, and before pregnancy (van der Wulp, Hoving amp de Vries, 2013). The findings indicated that counselling and psychological interventions are important in helping women abstain consuming alcohol during pregnancy (van der Wulp, Hoving amp de Vries, 2013). Not all studies were consistent in showing that psychological counselling was imperative in reducing alcohol consumption during pregnancy. The findings indicated that there are considerable reduction rates of alcohol consumption in women who have undergone education and counselling services. The importance of psychological counselling services lies in the fact that most women seek medical treatment to stop any addition in their realization of conceiving. According to the source of the results above women continue to engage in alcohol consumption even after the pregnancy is confirmed (McPide, Carruthers amp Hutchinson, 2012). These habits compromise the health of the mother and the child. In fact, most children record developmental delay and some severe mental illness on women who consumed alcohol during pregnancy (McPide, Carruthers amp Hutchinson, 2012). Reducing alcohol consumption during and before pregnancy is an important milestone for public health. It helps in addressing the key challenges that the health sector face in many jurisdictions. Children born of alcohol-dependent mothers always exhibit mental and wellbeing problems contributing to the rising number of health conditions affecting the public health sector (Van der Wulp, 2014). Therefore, achieving wellbeing and health status is impactful through the application of bio-psycho-social factors. It also helps in achieving sustainable and meaningful health improvement strategies. Psychological counselling is not limited to the health care professional but also extended to the communities, the private sectors, faith groups, employers and the public sectors in impacting meaningful change in the communities (Van der Wulp, 2014).

Psychological therapies help in advocating for change by developing resilience and enabling self-reflection (Smith, H., amp Stein, 2017). Counselling is helpful in advocating for the methods of addressing the interpersonal, personal, social, and emotional problems in the public health sector. Counselling does not major on providing advice but on giving solutions that are important in addressing a given situation (Smith, H., amp Stein, 2017). Counselling is about the exploration of the problem in the environment using objective and supportive mechanisms. It helps in identifying problems and the possible challenges existing within the groups. Counsellors are effective in managing and changing the pattern of alcohol consumption among pregnant women and those planning to get pregnant (Smith, H., amp Stein, 2017). Psychological therapies not only major on the individuals but also on the relationships that exist impacting behaviours, beliefs and values (Stephens et al, 2016). As a result, they lead to change and influencing behaviours. In addition, counselling therapies can have shown a significant reduction in alcohol consumption during pregnancy (Stephens et al, 2016). Women report that the counselling sessions expose them to information and consequently have changed their drinking habits (Stephens et al, 2016). Through therapies, public health can succeed in addressing the problems that arise within the relationships affecting pregnant mothers. It majors on the families and partners helping in building relationships and helping in mending the situation. It also helps in increasing the level of confidence to members have lost hope of their loved ones due to the addiction. Evidence-based psychological and counselling therapies are important in achieving the objectives of the public health (Stephens et al, 2016). It is also a cost-effective method since it can be divided across the communities decision makers reducing the budget to be incurred by the public health officials (Stephens et al, 2016).

4.4 Behaviour Change Construct

Behaviour change construct intervention is another intervention in reducing alcohol consumption during pregnancy that was discussed in the result section (von Sternberg, DiClemente amp Velasquez, 2018). The studies showed that behavioural change in the context of theoretical aspect is imperative in reducing alcohol consumption during pregnancies (Velasquez, 2017) (Jonas et al, 2012) (von Sternberg, DiClemente amp Velasquez, 2018) (Osterman, 2011) (Bazzo et al., 2015) (Hammer amp Inglin, 2014). Behaviour change construct can be categorized in the aspect of goal setting, behaviour substitution, information about health consequences, social support, feedback on behaviour, problem-solving, direct written materials, self-talk, prompts/ cues, behavioural contract and action planning. The health professionals and the midwives are in a better position of ensuring behaviour change among the pregnant and those intending to get pregnant. The evidence-based behaviour change mechanisms are more impactful in ensuring behaviour change (DiClemente et al, 2017). With the behaviour change construct the trans-theoretical model and the motivational interviewing approach is important in ensuring behaviour change is achieved(DiClemente et al, 2017). Behaviour change is a process where individuals should be given the opportunity to progress from one level to another. In this regard, it is expected that health practitioners are conscious in introducing mechanisms that compel pregnant women and those intending to get pregnant to change their behaviour. It should transition to complete action and maintenance stage that develops from the preparation, contemplation, and precontemplation (DiClemente et al, 2017).

Human behaviour defines a response to alcohol consumption and other lifestyle practices that leads to death in most countries. A small change can have a significant effect on the behaviour and implicate the health condition of an individual. It is important to understand human behaviour in an attempt to develop evidence-based solutions. The study observed that behaviour change is effective in addressing alcohol consumption among pregnant women and those intending to get pregnant. It entails the application of knowledge basing on the moderators of change and the action based moderators. Behaviour change construct requires the adoption of the best theories in an attempt to gain evidence-based change in the community.

4.5 Barriers of the Interventions

The campaigns aimed at preventing or reducing alcohol consumption during and before pregnancy are challenged by barriers to the interventions. Studies have shown that women indulge in alcohol consumption during pregnancy because of waiting for too long for addiction services, some have not adequate information concerning the harmful effect of alcohol during pregnancy, others indulge in alcohol due to controlling and unsupportive partners, some are indulged in hope and belief that change does not require help, women argued that they result in consuming alcohol during and when planning for pregnancy because of reduced self-esteem and feeling of depression, some women drink alcohol due to fear of child care services, the problems and reasons to have their children adopted and most important a feeling of guilt and shame (von Sternberg, 2018) (Velasquez, 2017) (Jonas et al, 2012) (von Sternberg, DiClemente amp Velasquez, 2018) (Osterman, 2011) (Bazzo et al., 2015) and (Hammer amp Inglin, 2014).

5.0 Conclusion and Recommendations

In conclusion, the objectives of the study were to examine the effectiveness of the interventions targeted on reducing alcohol consumption before and during pregnancy. The project aimed at identifying al the existing interventions, evaluating the efficacy of the intervention programs, identifying the challenges and the barriers that can limit the effectiveness of the strategies and providing recommendations on the various methods to improve on the interventions. The research project was guided by a series of research questions that were derived from the objectives. The main methodology utilized was a systematic literature review. It entailed the application of the inclusion and the exclusion criteria. The research was composed of reliable databases that used the key search questions as enlisted.

The main results obtained were the multimedia and education based intervention strategy. It was sourced from six credible authors. The intervention regarding psychological counselling was sourced from six authors, and the behaviour change construct intervention was sourced from the six authors. The balance indicates that the three main intervention strategies are important in reducing alcohol consumption during and before getting pregnant. Challenges and barriers of intervention in reducing alcohol consumption among pregnant women were also sourced from four credible authors.

The above research showed that intervention that uses media to reach out to the unreachable populations of women in their childbearing age were more helpful in changing the attitudes and beliefs. It was argued that there exist conflicting views on the intake of alcohol during pregnancy and could be a barrier that has blocked the public health sector from addressing the problem.in addition, the media and internet play a critical role in the current setting since women are more open on their challenges and reasons for consuming alcohol during pregnancy when in their crochet. In addition, mass media is in a better position to give everyone a custodian of the information leading to more impactful changes in the health sector. In addition, education services are also prominent. Most women engage in alcohol consumption since they lack knowledge against the practice. Psychological counselling is also very important since most pregnant women cite stress related reasons to prolonged consumption of alcohol. The counselling sessions reach out to their partners and help build a relationship and thus leading to long-lasting changes. In fact, some consume alcohol because they have lacked individuals to stand on the gap and help them solve issues relating to their loved ones, families and partners. A behaviour change construct was a very successful intervention that was identified in the research. It was noted that behaviour change is long lasting but require evidence-based approaches and theories that compel individuals to change.

To help completely reduce the consumption of alcohol during pregnancy it is important for the public health sector to offer specialized prenatal services and supports. Women should be encouraged to air their grievances and seek help concerning their additions. Through providing adequate knowledge and intervention women can reduce the barriers leading to a more supportive and effective care treatment. In addition, the relationship should be built between the service providers and pregnant women to advocate for more support. The health caregivers can also encourage change through the provision of encouraging feedback even in the slightest changes in the attempt to change the pregnant women perspective on consuming alcohol during pregnancy. It is also recommended to encourage the women especially those, in addition, to slowly reduce consumption as opposed to complete abstinence that can result in more devastating results.

It was noted that in the research abusing alcohol during pregnancy was attributed to economic and social challenges that face the women such as health issues, food insecurity, violence and abuse. In this respect, it is helpful to encourage women to respond to their immediate issues and needs. In addition, it is possible that some women are reluctant to challenge their grievances and views. In such a circumstance, the patient must be exercised to build a relationship based on trust. It is the role of a counsellor or the health practitioner to ensure the environment is conducive and safe for the women to discuss their views and worries. It is a good forum where trauma and violence informed approaches should be applied to help pregnant women and those intending to get pregnant to overcome the challenges. Respect is very important in the eradication of stigma and discrimination against such groups. Therefore, it is not advisable to act against the will of the women. In addition respect to the decisions made by the women in regard to disclosing their experiences. Through respect, the healing process is coping strategies are encouraged leading to full participation and inclusion in regard to well-being, care and health.

It is also the role of the public health givers to encourage relational aspect is developed throughout the process. It helps in connecting and building relationship among the pregnant women leading to a more social connection and help. It also helps in acknowledging the process of healing, change and growth which is visible more in a group. In addition, the women are capable of developed trust-based, supportive and long-term relationships. The pregnant women and those in their childbearing age have to be encouraged on self-determining. It is important to help them know they can determine their own life and make changes that affect them later in life. Women are looking for services that help them feel accepted, safe and respected. It helps them in copying personal behaviour and establishing cultural identity. Recognition also helps in overcoming challenges that are based on the socio-location and the cultural identity.

In conclusion, there is no safe alcohol consumption before or during and after giving birth. It is advisable that pregnant women do not consume any alcohol during their childbearing age. In case, a person is used in drinking them it should stop just before planning for pregnancy. It is important to know that the unborn baby inherits more risk associated with frequent consumption of alcohol. Refraining from alcohol consumption help pregnant women to refrain from health associated complications associated with alcohol and pregnancy. In addition, reducing consumption of alcohol helps stop the fetal alcohol spectrum disorder. Nevertheless, it is important to know that health information is very sensitive and require security inaccessibility. It is therefore important to prevent unauthorized access and ensure reasonable programs are in place. In the case of the social media then the accountability of the information disseminated need to be established. This study was limited to secondary information that was sourced from the areas described in the methodology. In this respect, the challenges, limitations and author bias from those sources are significantly transferred to this project. Therefore, its transferability should be based on the authors discretion. However, the study was efficient in addressing the research question and objectives. It was successful in establishing answers on the interventions that reduce alcohol consumption among pregnant women during, before and after pregnancy.

References

Bazzo, S., Battistella, G., Riscica, P., Moino, G., Marini, F., Bottarel, M., Padovan, M. (2015). Evaluation of a Multilevel and Integrated Program to Raise Awareness of the Harmful Effects of Prenatal Alcohol Exposure in a Local Community. Alcohol amp Alcoholism. Supplement, 50(6), 708715. https//doi-org.liParyproxy.griffith.edu.au/10.1093/alcalc/agv051Centres for Disease Control and Prevention. (2018). Alcohol Use in Pregnancy. Accessed from https//www.cdc.gov/ncbddd/fasd/alcohol-use.html

Comasco, E., Hallberg, G., Helander, A., Oreland, L., amp Sundelin-Wahlsten, V. (2012). Alcohol Consumption Among Pregnant Women in a Swedish Sample and Its Effects on the Newborn Outcomes. Alcoholism Clinical amp Experimental Research, 36(10), 17791786. https//doi-org.liParyproxy.griffith.edu.au/10.1111/j.1530-0277.2012.01783.xCrawfordWilliams, F., Fielder, A., MikockaWalus, A., amp Esterman, A. (2015). A criticalreview of public health interventions aimed at reducing alcohol consumption and/or increasing knowledgeamong pregnant women. Drug and alcohol review, 34(2), 154-161.

de Paula Gebara, C. F., de Castro Bhona, F. M., Ronzani, T. M., Loureno, L. M., amp Noto, A. R. (2013). Pief intervention and decrease of alcohol consumption among women a systematic review. Substance abuse treatment, prevention, and policy, 8(1), 31.

Department of Health. (2019). Alcohol During Pregnancy and Peastfeeding. Australian Government. Accessed from https//beta.health.gov.au/health-topics/alcohol/alcohol-throughout-life/alcohol-during-pregnancy-and-Peastfeeding

Dewey, A. amp Drahota, A. (2016). Introduction to systematic reviews online learning module Cochrane Training. https//training.cochrane.org/interactivelearning/module-1-introduction-conducting-systematic-reviewsDiClemente, C. C., Corno, C. M., Graydon, M. M., Wiprovnick, A. E., amp Knoblach, D. J. (2017). Motivational interviewing, enhancement, and Pief interventions over the last decade A reviewof reviews of efficacy and effectiveness. Psychology of Addictive Behaviors, 31(8), 862.

Fetal Alcohol Spectrum Disorder. (2019). Effective Strategies to Prevent Alcohol use in Pregnancy. Ontario Network of Expertise. Public Health of Agency of Canada. http//www.fasdontario.ca/cms/service-areas/prevention/effective-strategies-to-prevent-alcohol-use-in-pregnancy/

Fletcher, O. V., May, P. A., Seedat, S., Sikkema, K. J., amp Watt, M. H. (2018). Attitudes toward alcoholuse during pregnancy among women recruited from alcohol-serving venues in Cape Town, South Africa A mixed-methods study. Social Science amp Medicine, 215, 98-106.

Gough, David A., David Gough, Sandy Oliver, and James Thomas. (2012). An Introduction to Systematic Reviews. Systematic Reviews. London SAGE.

Hammer, R., amp Inglin, S. (2014). I dont think its risky, but pregnant womens risk perceptions ofmaternal drinking and smoking. Health, Risk amp Society, 16(1), 2235. https//doi-org.liParyproxy.griffith.edu.au/10.1080/13698575.2013.863851Holden, K. B., McKenzie, R., Pruitt, M. V., Aaron, M. K., amp Hall, M. S. (2012). Depressivesymptoms, substance abuse, and intimate partner violence among pregnant women of diverse ethnicities. Journal of health care for the poor and underserved, 23(1), 226.

Howlett, H., Mackenzie, S., Strehle, E. M., Rankin, J., amp Gray, W. K. (2019). A Survey of Health Care Professionals Knowledge and Experience of Foetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy. Clinical Medicine Insights Reproductive Health, 13, 1179558119838872.

Leppo, A., Hecksher, D., amp Tryggvesson, K. (2014). Why take chances Advice on alcohol intake topregnant and non-pregnant women in four Nordic countries. Health, Risk amp Society, 16(6), 512529. https//doi-org.liParyproxy.griffith.edu.au/10.1080/13698575.2014.957659McPide, N., Carruthers, S., amp Hutchinson, D. (2012). Reducing alcohol use during pregnancy listening to women who drink as an intervention starting point. Global health promotion, 19(2), 6-18.

Misir, D., amp Paarlberg, K. M. (2017). A Pregnant Woman Who Could Not Stop Drinking Managementof Alcohol Abuse in Pregnancy. In Bio-Psycho-Social Obstetrics and Gynecology (pp. 127-144). Springer, Cham.

Osterman, R. (2011). Feasibility of Using Motivational Interviewing to Decrease Alcohol Consumption During Pregnancy. Journal of Addictions Nursing (Taylor amp Francis Ltd), 22(3), 93102. https//doi-org.liParyproxy.griffith.edu.au/10.3109/10884602.2011.585723

Rahi, S. (2017). Research design and methods A systematic review of research paradigms, sampling issues and instruments development. International Journal of Economics amp Management Sciences, 6(2), 1-5.

Smith, H., amp Stein, K. (2017). Psychological and counselling interventions for female genital mutilation. International Journal of Gynecology amp Obstetrics, 136, 60-64.

Smith, M. K., amp Denali, D. L. (2014). Social media in health education, promotion, andcommunication Reaching rural Hispanic populations along the USA/Mexico border region. Journal of Racial and Ethnic Health Disparities, 1(3), 194-198.

Stephens, S., Ford, E., Paudyal, P., amp Smith, H. (2016). Effectiveness of psychological interventionsfor postnatal depression in primary care a meta-analysis. The Annals of Family Medicine, 14(5), 463-472.

Tzilos, G. K., Sokol, R. J., amp Ondersma, S. J. (2011). A Randomized Phase I Trial of a Pief Computer-Delivered Intervention for Alcohol Use During Pregnancy. Journal of Womens Health (15409996), 20(10), 15171524. https//doi org.liParyproxy.griffith.edu.au/10.1089/jwh.2011.2732

van der Wulp, N. Y., Hoving, C., amp de Vries, H. (2013). A qualitative investigation of alcohol use advice during pregnancy Experiences of Dutch midwives, pregnant women andtheir partners. Midwifery, 29(11), e89-e98.

van der Wulp, N. Y., Hoving, C., Eijmael, K., Candel, M. J., van Dalen, W., amp De Vries, H. (2014). Reducing alcohol use during pregnancy via health counselling by midwives and internet-basedcomputer-tailored feedback a cluster randomized trial. Journal of medical Internet research, 16(12), e274.

Velasquez, M. M., von Sternberg, K. L., Floyd, R. L., Parrish, D., Kowalchuk, A., Stephens, N. S., ... amp Mullen, P. D. (2017). Preventing alcohol and tobacco exposed pregnancies CHOICES plus inprimary care. American journal of preventive medicine, 53(1), 85-95.

von Sternberg, K., DiClemente, C. C., amp Velasquez, M. M. (2018). Profiles of behaviour change construct for reducing alcohol use in women at risk of an alcohol-exposed pregnancy. Psychology of Addictive Behaviors, 32(7), 749.

Yen, C.-F., Yang, M.-S., Lai, C.-Y., Chen, C.-C., Yeh, Y.-C., amp Wang, P.-W. (2012). Alcohol Consumptionafter the Recognition of Pregnancy and Correlated Factors among Indigenous Pregnant Womenin Taiwan. Maternal amp Child Health Journal, 16(2), 528538. https//doi-org.liParyproxy.griffith.edu.au/10.1007/s10995-011-0747-3Young, B., Lewis, S., Katikireddi, S. V., Bauld, L., Stead, M., Angus, K. amp Ashie, A. (2018). Effectivenessof mass media campaigns to reduce alcohol consumption and harm a systematic review. Alcohol and alcoholism, 53(3), 302-316.

Students Also Found These Useful :

Online Assignment Help

Public Health Alcohol Consumption Epidemiological Data Report Writing Assessment Answer

Looking For Complete Assignment Sample Get It On WhatsApp