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Women with substance use issues and their children have unique needs that are best met through collaborative and coordinated service delivery offered by a variety of agencies. However, in Canada and elsewhere, services tend to be fragmented and fail to address children's needs. This study aimed to describe the partnership patterns, activities, and qualities among Canadian agencies serving women with addictions and to determine predictors of partnerships. We found that a number of partnerships exist, and that the extent and characteristics of these partnerships vary. Agency responsiveness to clients was predictive of sending referrals whereas friendliness predicted joint programming and consultation. Four central agencies played key linkage roles. Efforts should be made to build on the social capital inherent in these agencies to strengthen existing networks, further develop linkages to improve service delivery, and promote evidence-informed practice in a field where there is an identified research-practice gap. (Contains 5 tables and 1 figure.)

Aims: The study objectives were to: (1) understand the value attributed to the lived experience of addiction and recovery among professionals working in addiction agencies serving women in Canada and (2) describe how lived experience influence practice-related decision-making. Methods: A descriptive qualitative study was conducted with a purposeful sample of 26 addiction professionals from 24 addiction agencies. Subsequently, a secondary analysis was conducted to identify data that would provide greater insight into issues related to the use of lived experience in decision-making. Findings: Participants who either described their personal history of addiction or discussed the influence of others' lived experience on decisions made within the agency indicated that: (1) some professionals perceive lived experience and research evidence as two dichotomous concepts, viewing lived experience as more credible than research evidence; (2) personal experience with a particular treatment can guide treatment decisions; (3) strong adherence to only one source of evidence leads to intra-organizational conflict and (4) different sources of evidence in decision-making need to be acknowledged to inform practice. Conclusion: The addiction field can benefit from increased understanding of decision-making as a multifaceted process involving different sources of evidence, including addiction professionals' lived experiences of addiction and recovery.

Objective To determine the likelihood of participating in group prenatal care (GPC) and associated factors among low-risk women receiving traditional prenatal care from obstetricians, family physicians or midwives, and to determine factors associated with likelihood of participating. Methods Prior to completing a self-administered questionnaire, a 2-min compiled video of GPC was shown to pregnant women receiving traditional prenatal care. Data were collected on opinions of current prenatal care, GPC, and demographics. Biologically plausible variables with a p value ≤0.20 were entered in the multivariable logistic regression model and those with a p value Results Of 477 respondents, 234 [49.2 %, 95 % confidence interval (CI) 44.6-53.6 %] reported being 'definitely' or 'probably likely' to participate in GPC. Women were more likely to participate in GPC if they had at least postsecondary education [adjusted odds ratio (aOR) 1.84, 95 % CI 1.05-3.24], had not discussed labour with their care provider (aOR 1.67, 95 % CI 1.12-2.44), and valued woman-centeredness ('fairly important' aOR 2.81, 95 % CI 1.77-4.49; 'very important' aOR 4.10, 95 % CI 2.45-6.88). Women placed high importance on learning components of GPC. The majority would prefer to be with similar women, especially in age. About two-thirds would prefer to have support persons attend GPC and over half would be comfortable with male partners. Conclusion Approximately half of women receiving traditional prenatal care were interested in participating in GPC. Our findings will hopefully assist providers interested in optimizing satisfaction with traditional prenatal care and GPC by identifying important elements of each, and thus help engage women to consider GPC., Author(s): Sarah D. McDonald[sup.1] , Wendy Sword[sup.2] , Leyla N. Eryuzlu[sup.3] , Binod Neupane[sup.4] , Joseph Beyene[sup.5] , Anne B. Biringer[sup.6] Author Affiliations: (1) Division of Maternal-Fetal Medicine, Departments of [...]

Across cultures, approximately one third of people with drug dependence are women of child-bearing age. There is emerging evidence regarding the effectiveness of integrating pregnancy, parenting, and child development services with addiction services. In 2007, we conducted a national survey of addiction agencies serving women to provide preliminary information on available services. Approximately one half of the program managers reported providing some type of pregnancy-, parenting-, or child-related services, the majority of which were external referrals, and very few agencies provided any services for children under 5 years. These findings indicate a gap in services in Canada. Reliable data on services for women with substance use issues and their children is essential to ensure appropriate resource allocation. Program managers reported preferring to receive practice-related research information through face-to-face contact, information which will be helpful to knowledge translation efforts.

This qualitative study explored health sciences students' perceptions of their experiences in online problem based learning (PBL) and focused on their views about learning and group process in the online environment. Participants were novices to online learning and highly experienced in PBL, therefore, they could reflect on past face-to-face PBL experiences. Three groups of learners were involved, including undergraduate nursing and midwifery students and graduate students in a neonatal nurse practitioner program. Findings are presented using the six steps of the PBL process (Rideout & Carpio, 2001). Results indicated that it is feasible to conduct PBL online. Students felt that it increased their flexibility for learning, enhanced their ability to deeply process content, and provided access to valuable learning resources. Students experienced a period of adaptation to the online environment, perceived a heavy workload, and had difficulties making group decisions online. In addition to using asynchronous communication, chats (synchronous communication) were valued to support group decision-making online. Students appreciated validation of their online contributions from their peers and wanted clear expectations of what constituted successful tutorial participation from their tutors. Although online PBL can work effectively, tutors and students need to develop online literacy skills to smooth their transition to an online PBL environment.

Undergraduate nursing students at McMaster University are mentored by program alumni. Feedback from surveys and group discussions revealed benefits beyond career and personal development, resulting from having experienced the same educational program. Alumni appreciated the opportunity to reconnect with their alma mater. (SK)

Objective: This study aimed to understand physical, knowledge, psychological, and lifestyle factors associated with planned excess gestational weight gain (GWG), a strong and potentially modifiable predictor of actual excess GWG, which contributes to maternal and child obesity along with other adverse maternal and fetal outcomes. Methods: This is a secondary analysis of data from a prospective cohort study where women completed a questionnaire in early pregnancy. Women were asked to report their planned GWG, which was then categorized as above, within, or below the Institute of Medicine (IOM) guidelines. Univariable and multivariable analyses were performed to identify variables associated with planned excess GWG. Results: Of 970 women included in the analysis, 300 reported a planned GWG above the IOM guidelines. Predictors of excess planned GWG included reporting healthcare provider recommendations to gain weight above the guidelines (adjusted odds ratio [aOR], 62.17; 95% confidence interval [CI], 13.75–281.03), overestimating first trimester weight gain recommendations (aOR, 1.83; 95% CI, 1.21–2.77), believing in risks to the baby with inadequate GWG (aOR 2.16; 95% CI,1.29–3.60), inaccurate self-perceived prepregnancy body size (aOR, 1.88; 95% CI, 1.22–2.89), low or high emotional suppression (aOR, 1.78; 95% CI, 1.06–2.99; and aOR, 2.57; 95% CI, 1.21–5.45, respectively), physical inactivity (aOR, 1.10; 95% CI, 1.03–1.17), and overweight or obesity (aOR, 5.76; 95% CI, 3.70–8.98; and aOR, 11.46; 95% CI, 6.54–20.06, respectively). Protective factors against planned excess GWG included increased maternal age (aOR, 0.95; 95% CI, 0.92–0.99), and believing in risks to themselves with inadequate GWG (aOR 0.64; 95% CI, 0.42–0.97) or believing in risks to the baby with excess GWG (aOR, 0.49; 95% CI, 0.27–0.88). Conclusions: Women with overweight or obesity are at greater risk of prospectively planning excess GWG, and may especially benefit from healthcare provider counseling on appropriate GWG. Other modifiable factors for planned excess GWG included knowledge about risks of inappropriate weight gain and physical inactivity. [ABSTRACT FROM AUTHOR]

Abstract Background Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings. Methods In a systematic review of 121documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system). Results On average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention. Conclusions As has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations for the paucity of feasibility information and provide suggestions for better reporting to promote diffusion of evidence-based practices.

Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and interpersonal care processes emerged as being most essential to quality care. These processes are important as they have a role in mitigating adverse outcomes, promoting involvement of women in their own care, and keeping women engaged in care. The findings suggest key considerations for the planning, delivery, and evaluation of prenatal care. Most notably, care should be woman-centred and embrace shared decision making as an essential element.

Abstract Background Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes. Objectives As part of larger systematic review to examine the effectiveness of integrated programs for mothers with substance abuse issues, we performed a systematic review of studies published from 1990 to 2011 with data on parenting outcomes. Methods Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline, the treatment program included at least one specific substance use treatment and at least one parenting or child service, and there were quantitative data on parenting outcomes. We summarized data on parenting skills and capacity outcomes. Results There were 24 cohort studies, 3 quasi-experimental studies, and 4 randomized trials. In the three randomized trials comparing integrated programs to addiction treatment-as-usual (N = 419), most improvements in parenting skills favored integrated programs and most effect sizes indicated that this advantage was small, ds = -0.02 to 0.94. Results for child protection services involvement did not differ by group. In the three studies that examined factors associated with treatment effects, parenting improvements were associated with attachment-based parenting interventions, children residing in the treatment facility, and improvements in maternal mental health. Conclusions This is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting. The limited available evidence supports integrated programs, as findings suggest that they are associated with improvements in parenting skills. However, more research is required comparing integrated programs to addiction treatment-as-usual. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the parenting needs of women with substance abuse issues.