Survey: Responses to Alcohol and Pregnancy Policy (RAPP)

Page 1: Welcome [landing page]
Thank you for following this link. 
This research will explore the impact of the introduction of mandatory alcohol screening from the perspective of midwives based in the U.K.
We are interested in hearing from you if you are:
* A qualified midwife.
* Currently working as a midwife in the U.K.
The survey should take around 15-25 minutes to complete.
About the RAPP Project
Our names are Fiona Woollard, Rachel Arkell and Rebecca Brione.  Fiona is a Professor in Philosophy at the University of Southampton in the United Kingdom <https://www.southampton.ac.uk/philosophy/about/staff/fw1n09.page> Rachel is a Research and Projects Officer at the Centre for Reproductive Research & Communication at BPAS.  Rebecca is a Research Assistant on our project, RAPP (Responses to Alcohol and Pregnancy Policy). 
The RAPP project <hyperlink to project webpage Š see separate document for webpage text> is a collaboration between the Centre for Reproductive Research and Communication at BPAS and the University of Southampton, funded by the Public Policy|Southampton New Things Fund < https://www.southampton.ac.uk/publicpolicy/support-for-researchers/New%20Things%20Fund/new-things-fund.page>.
This study was approved by the Faculty Research Ethics Committee (FREC) at the University of Southampton (Ethics/ERGO Number: 70549)











Page 2: Information and consent
Study Title: RAPP: Responses to Alcohol and Pregnancy Policy
Researchers: Fiona Woollard, Rachel Arkell, Rebecca Brione
University email: f.woollard@soton.ac.uk
Ethics/ERGO no: 70549
Version and date: Version 1, 21/01/2022
What is the research about?
We are trying to understand the impact of the introduction of mandatory alcohol screening from the perspective of midwives based in the U.K.
We are inviting you to participate in a study for the RAPP Project.  We want to hear the views of fully qualified midwives currently practising in the U.K. about: mandatory alcohol screening as part of routine antenatal care; future plans to transfer alcohol information to a childÕs health record; how this has impacted their relationships with patients; how this has impacted their view of their own role.
What will happen to me if I take part? 
The first part of the study involves completing an anonymous questionnaire which should take approximately 15-25 minutes of your time. You will be able to save your answers and return to the survey later. If you are happy to complete this survey, you will need to tick (check) the box below to show your consent. As this survey is anonymous, the research team will not be able to know whether you have participated, or what answers you provided.
We will also be running an online focus group.  This will take place over Microsoft Teams on [date/range to be confirmed].  After completing the survey, if we are still recruiting for the focus group, you will be given an option to give your contact details so we can contact you about participating in the online focus group. The contact details form is separate from the research survey.  The researchers will not be able to link your contact details to your answers to the research survey. If you are selected to take part in the online focus group, you will be given a second participant information sheet with more information about that part of the study to help you decide whether to take part.  You will also be asked to complete a separate consent form for the online focus group.    
Why have I been asked to participate? 
You have been asked to take part because you are a fully qualified midwife, currently working as a midwife in the U.K.
If you have received an invitation to participate through email, this is because the owner of the mailing list agreed to forward to you information about this study on the research teamÕs behalf.
We are aiming to recruit around 500 participants for the online survey and five participants for the focus group.
Do I have to take part?
No. Taking part in this study is voluntary. You may stop at any point during the survey for any reason by closing the browser. Partly completed surveys will be automatically saved and included in the analysis.
You do not have to answer all the questions if you do not wish to do so. 

What information will be collected? 
The questions in this survey ask for information in relation to (A) the length of time you have worked as a midwife in the UK, your level of seniority, and when you last carried out a booking appointment; (B) your understanding of current practice regarding alcohol screening in pregnancy; (C) your views on mandatory alcohol screening as part of routine antenatal care; (D) the effects this has on your relationship with patients; and (E) your understanding of your role as a midwife.  If you have been negatively affected by issues related to alcohol use in pregnancy or changes to your role and relationships with patients, some of the information we ask for may be distressing. However, we do not expect most participants to find the topics distressing.
Some of the survey questions contain textboxes where you will be asked to type in your own answers. Please note that in order for this survey to be anonymous, you should not include in your answers any information from which you, or other people, could be identified. 
You do not have to answer all the questions if you do not wish to do so.

How do I find out about the results of the study?
Please email f.woollard@soton.ac.uk if you would like us to share any outputs arising from the study with you.

What are the possible benefits of taking part? 
If you decide to take part in this study, your participation will contribute to knowledge in this area of research. 
We know that as a midwife you are very busy. To thank you for your time, you will be offered the chance to enter into a prize draw.  The original prize draw was for ten prizes of an £40 Love2Shop Highstreet Gift Voucher each <https://www.highstreetvouchers.com>.  The closing date for the original prize draw was 31st March 2022. As noted, the survey date has been extended.  We are required to honour the closing date of the original prize draw. We will thus run a second prize draw for those participating in the survey after 31st March 2022.  Again, there will be ten prizes of an £40 Love2Shop Highstreet Gift Voucher each <https://www.highstreetvouchers.com>.   
The contact details form for the prize draw is separate from the research survey.  The researchers will not be able to link your contact details to your answers to the research survey.  

Are there any risks involved?
It is not expected that taking part in this study will cause you any psychological discomfort and/or distress, however, should you feel uncomfortable you can leave the survey at any time or contact the following resources for support: 
https://www.makebirthbetter.org/trauma-support-for-professionals
https://www.makebirthbetter.org/help-for-professionals
https://www.rcm.org.uk/caring-for-you-hub-home/health-and-wellbeing-support/

What will happen to the information collected?
All information collected for this study will be stored securely on a password protected computer and backed up on a secure server. The data will be checked for any identifying information and any identifying information will be removed.  
The information collected will be analysed and published in policy briefs, reports and academic papers. It may also be used in conference presentations or work aimed at a popular audience. These publications may include quotes from responses to free textboxes
The University of Southampton conducts research to the highest standards of ethics and research integrity. In accordance with our Research Data Management Policy, in due course, the data (with any identifying information removed) will be archived in the University of Southampton data repository so it can be used for future research and learning.
What happens if there is a problem?
If you are unhappy about any aspect of this study and would like to make a formal complaint, you can contact the Head of Research Integrity and Governance, University of Southampton, on the following contact details: Email: rgoinfo@soton.ac.uk, phone: + 44 2380 595058. 
Please quote the Ethics/ERGO number above. Please note that by making a complaint you might be no longer anonymous.
More information on your rights as a study participant is available via this link: 
https://www.southampton.ac.uk/about/governance/participant-information.page 
Thank you for reading this information sheet and considering taking part in this research. 
?Please tick (check) this box to indicate that you have read and understood information on this form, are aged 18 or over and agree to take part in this survey.




Page 3: Eligibility
These questions will help us to determine whether you are eligible to take this survey.
01. Are you currently working as a qualified midwife?
?Yes
?No
02. Where are you working as a qualified midwife?
?England
?Wales
?Scotland
?Northern Ireland 
?Outside the U.K.

If response to question 01 and/or 02 is no/outside the U.K., the following text will be displayed: 
Thank you for your interest in taking part in this survey, however at this time we are only looking for qualified midwives who are currently practicing as midwives inside the U.K.

Page 4Ź: Section 1Ź: Information About You

We would like to start by asking some questions about your employment, which will help us with our research.

1. How many years ago did you qualify as a midwife?
a. 5 years or less
b. 6-10 years
c. 11-15 years
d. 16-20 years
e. More than 20 years

2. How would you describe your role?
a. Junior Midwife
b. Senior Midwife
c. Midwifery Consultant
d. Prefer not to say
e. Other [Open Text box]


3. When did you last carry out a booking appointment?
a. Within the last week
b. Within the last month
c. Within the last year
d. More than 1 year ago
e. Prefer not to say


Page 5: Section 2: Current Practices 

In this section we would like to find out what your current practice looks like when addressing alcohol use throughout pregnancies.

Please note, all questions are about routine antenatal care as opposed to circumstances when you suspect alcohol may be a problem for an individual.

1. What kind of information do you usually record during routine antenatal care (Tick all that apply).
a. Previous alcohol intake (do not record, record at one appointment, record at more than one appointment, record at more than one appointment, prefer not to say)
b. Current alcohol intake (do not record, record at one appointment, record at more than one appointment, record at more than one appointment, prefer not to say)
c.  ŌBingeÕ drinking (drinking > 6 units on a single drinking occasion) (do not record, record at one appointment, record at more than one appointment, record at more than one appointment, prefer not to say)

2. Does your Trust currently require you to record the following information during routine antenatal care: 
a. Previous alcohol intake (No, Yes - at one appointment, Yes- at more than one appointment, I do not know, prefer not to say)
b. Current alcohol intake (No, Yes - at one appointment, Yes- at more than one appointment, I do not know, prefer not to say)
c.  ŌBingeÕ drinking (drinking > 6 units on a single drinking occasion) (No, Yes - at one appointment, Yes- at more than one appointment, I do not know, prefer not to say)

   (If you work for more than one Trust, your answer should be about the Trust that you spend most time working for.)
   
3. What happens in your Trust if you do not enter alcohol information into the online maternity record?
a.  It is not possible to complete the rest of the online record unless alcohol information is recorded
b. It is possible to complete the rest of the online maternity record without entering the alcohol information.
c. DonÕt know.
d. Prefer not to say

Page 6: Section 3: Proposals relating to Mandatory Alcohol Screening

In this section we would like to ask you for your views on recent proposals to introduce mandatory alcohol screening as part of Ōroutine antenatal careÕ.

By alcohol screening we are referring to attempts to capture information on all alcohol consumption through questions/questionnaires.

No prior knowledge to any of the recent proposals is required, we are just interested in your professional opinion.

1. Do you think questions about alcohol use should be asked at the booking appointment as part of routine antenatal care?

a. Yes.
b. No.
c. DonÕt know.
d. Prefer not to say.

2. Do you think questions about alcohol use should be asked at every appointment as part of routine antenatal care?

a. Yes.
b. No.
c. DonÕt know.
d. Prefer not to say.


3. What information about alcohol use should be recorded?
a. Information about alcohol use should be recorded for all patients as part of routine antenatal care 
b. Only information pointing to ŌriskyÕ alcohol consumption should be recorded
c. DonÕt know.
d. Prefer not to say.

4. Should alcohol screening require consent?
a. Yes.
b. No.
c. DonÕt know.
d. Prefer not to say.

5. In 2019, the National Institute of Health and Care Excellent (NICE) opened consultation for their Draft Quality Standards on Foetal Alcohol Spectrum Disorders (FASD). This draft proposed mandatory screening as part of routine antenatal care so this information is available for children and families seeking an FASD diagnosis.

Before starting this survey, were you aware of the consultation for the NICE Draft Quality Standards on FASD?
a. Yes
b. No
c. Prefer not to say

6. To what extent do you agree with the following statements: (Strongly agree, agree, neither agree or disagree, disagree, strongly disagree, I donÕt know, Prefer not say)
a. Recording alcohol information is already part of Ņroutine antenatal careÓ
b. Routine alcohol screening fails to respect patientsÕ privacy rights 
c. Routine alcohol screening fails to respect medical confidentiality 

7. To what extent do you agree with the following statements: (Strongly agree, agree, neither agree or disagree, disagree, strongly disagree, I donÕt know, Prefer not say)
a. Routine alcohol screening is justified by the UK Chief Medical OfficerÕs low-risk alcohol guideline (2016) which states there is no safe level of alcohol consumption during pregnancy 
b. Routine alcohol screening is justified by providing information for a diagnosis of FASD 
c.  A high percentage of adopted children may benefit from alcohol information being recorded. Because of this, routine alcohol screening is justified.
d. Having information available about alcohol consumption during pregnancy can lead to earlier diagnoses and better outcomes for affected children. Because of this, routine alcohol screening is justified.


8. How comfortable would you feel routinely recording alcohol consumption information as part of routine antenatal care at booking appointments?
a. Very comfortable
b. Comfortable
c. Neither comfortable, nor uncomfortable
d. Uncomfortable
e. Very Uncomfortable
f. DonÕt Know
g. Prefer Not to Say 

9. How comfortable would you feel routinely recording alcohol consumption information as part of routine antenatal at every contact with patients? 
a. Very comfortable
b. Comfortable
c. Neither comfortable, nor uncomfortable
d. Uncomfortable
e. Very Uncomfortable
f. DonÕt Know
g. Prefer Not to Say 


Page 7: Section 4: Proposals relating to Transfer of Alcohol Information to ChildrenÕs Health Records 

In this section we would like to ask you for your views on recent proposals to include information on alcohol use in pregnancy on the childÕs health record. 

No prior knowledge to any proposals is required, we are just interested in your professional opinion.

1. To what extent do you agree with the following statements: (Strongly agree, agree, neither agree or disagree, disagree, strongly disagree, I donÕt know, Prefer not say)
a. A high percentage of adopted children may benefit from alcohol information being recorded and made readily available. Because of this, mandatory transferral of alcohol information from maternal records to childrenÕs health records is justified
b. Having information available about alcohol consumption during pregnancy can lead to earlier diagnoses and better outcomes for affected children. Because of this, mandatory transferral of alcohol information from maternal records to childrenÕs health records is justified.

2. On what basis should information about all and any alcohol consumption be transferred from maternity record to childrenÕs health records? 
a. It should automatically be transferred 
b. It should be transferred on an opt-out basis
c. It should be only transferred with explicit consent from the person who gave birth
d. It should not be transferred.
e. I donÕt know.
f. Prefer not to say.


3. On what basis should information about ŌriskyÕ alcohol consumption be transferred from maternity record to childrenÕs health records? 
a. It should automatically be transferred 
b. It should be transferred on an opt-out basis
c. It should be only transferred with explicit consent from the person who gave birth
d. It should not be transferred.
e. I donÕt know.
f. Prefer not to say.


4. To what extent do you agree with the following statements: (Strongly agree, agree, neither agree or disagree, disagree, strongly disagree, I donÕt know, Prefer not say)
a. Automatic mandatory transferral of alcohol information from maternal records to childrenÕs health records does not respect patientsÕ privacy rights
b. Mandatory transferral of alcohol information from maternal records to childrenÕs health records on an opt-out basis does not respect patientsÕ privacy rights
c. Mandatory transferral of alcohol information from maternal records to childrenÕs health records with explicit consent does not respect patientsÕ privacy rights


5.  How comfortable would you feel knowing that information that you recorded on antenatal alcohol consumption during maternity care would be transferred to the childÕs health records post-birth?
a. Very comfortable
b. Comfortable
c. Neither comfortable, nor uncomfortable
d. Uncomfortable
e. Very Uncomfortable
f. DonÕt Know
g. Prefer Not to Say 


Page 9: Section 5: Potential Impact on Relationship with Patients  

In this section we would like to ask you for your views on whether you think recent proposals mentioned earlier in this survey will have any impact on your relationships with patients. No prior knowledge to any policy documents is required, we are just interested in your professional opinion.

1. What effects do you think mandatory alcohol screening could have on patients? [Agree, Disagree, Prefer not to say]
a. It could cause patients to be feel judged
b. It could cause patients to feel guilt and/or shame
c. It could undermine trust between a patient and their midwife.
d. It could lead to patients underreporting their alcohol consumption.
e. It could lead to patients disengaging with maternity services.

2. What effects do you think transfer of information about alcohol consumption could have on patients? [Agree, Disagree, Prefer not to say]
a. It could cause patients to be feel judged
b. It could cause patients to feel guilt and/or shame
c. It could undermine trust between a patient and their midwife.
d. It could lead to patients underreporting their alcohol consumption.
e. It could lead to patients disengaging with maternity services.

Page 10: Section 6: Potential Impact on your Role as a Midwife
In this section we would like to ask you whether you think these proposals could impact on your role as a midwife.
This includes any potential impact on how you view yourself and professional identity in carrying out your caring responsibilities with patients.
1. How do you think mandatory screening would impact your role as a midwife?
a. Overall negative impact.
b. Overall positive impact.
c. Overall neutral impact.
d. No impact.
e. Prefer not to say.

2. How do you think transferral of information to a childÕs health record would impact your role as a midwife?
a. Overall negative impact.
b. Overall positive impact.
c. Overall neutral impact.
d. No impact.
e. Prefer not to say.

Using this text box, please tell us how (if at all) mandatory alcohol screening and subsequent transferral of information to a childÕs health record would impact how you view your role as a midwife, and why. 
Please note that in order for this survey to be anonymous, you should not include in your answers any information from which you, or other people, could be identified.

Page 11: Any other comments
Using this text box, please enter any other comments. 
Please note that in order for this survey to be anonymous, you should not include in your answers any information from which you, or other people, could be identified.


Page 12: Thank You

Thank you for taking the time to complete this survey. We know that as a midwife you are very busy. To thank you for your time, you will be offered the chance to enter into a prize draw.  Your prize draw will have ten prizes of a £40 Love2Shop Highstreet Gift Voucher <https://highstreetvouchers.com> each. 

We will also be running an online focus group.  This will take approximately 1.5- 2 hours and will take place over Microsoft Teams on [date/range to be confirmed].  Participants in the focus groups will be offered a £50 Love2Shop Highstreet Gift Voucher <https://highstreetvouchers.com> to thank them for their time. [If we have finished recruitment for the focus group, we will replace the information about the focus group with ŅWe are sorry, we are not able to offer you the opportunity to be part of our focus group. Recruitment for the focus group has now finished.Ó]  

To enter the prize draw or to agree to be contacted about the focus group, please click here <link to separate survey>

Page 13: Separate Survey [Version 1 Š if we are still recruiting for the focus group.]
Thank you for taking the time to complete this survey. We know that as a midwife you are very busy. To thank you for your time, you will be offered the chance to enter into a prize draw.  There will be ten prizes of a £40 Love2shop gift voucher < Love2shop Vouchers | Free Delivery | Buy Now | Use In 20,000 Stores (highstreetvouchers.com)> each. 

1. Do you want to be entered for the prize draw? [Yes/ No]
 
2. We will also be running an online focus group.  This will take place over Microsoft Teams on [date/range to be confirmed].  If you are selected to take part in the online focus group, you will be given a second participant information sheet with more information about that part of the study to help you decide whether to take part.  You will also be asked to complete a separate consent form for the online focus group.     
A. Can we contact you to ask you to participate in the focus group? [Yes/No]
[If they say Yes to 2A]
In order to keep the research survey anonymous, your answers on this page cannot be linked to your answers to the research survey.  Unfortunately, this means we have to ask you some questions again!


       2B. How many years ago did you qualify as a midwife?
a. 5 years or less
b. 6-10 years
c. 11-15 years
d. 16-20 years
e. More than 20 years

2.B How would you describe your role?
f. Junior Midwife
g. Senior Midwife
h. Midwifery Consultant
i. Prefer not to say
j. Other [Open Text box]


2.C When did you last carry out a booking appointment?
k. Within the last week
l. Within the last month
m. Within the last year
n. More than 1 year ago
o. Prefer not to say

 
[If they answered yes to 1 or 2.] 
 
3. Please enter the email address that we can use to contact you. The researchers will not be able to link your contact details to your answers to the research survey.
Email address [........]
Page 14: Separate Survey [Version 2 Š if we are no longer recruiting for the focus group.]
Thank you for taking the time to complete this survey. We know that as a midwife you are very busy. To thank you for your time, you will be offered the chance to enter into a prize draw.  There will be ten prizes of a £40 Love2shop gift voucher < Love2shop Vouchers | Free Delivery | Buy Now | Use In 20,000 Stores (highstreetvouchers.com)> each. 

1. Do you want to be entered for the prize draw? [Yes/ No]

 
[If they answered yes to 1.] 
 
2. Please enter the email address that we can use to contact you. The researchers will not be able to link your contact details to your answers to the research survey.
Email address [........]

	

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