Table 1 Implementation Strategy Summary

Leadership and management

• Monthly meetings were held with management from antenatal services to elicit support.

• Service managers distributed resources to staff and attended training sessions.

• Performance measures related to the provision of the model of care were monitored and reported on.

Labour time:

• Health district implementation support officer and manager.

• Health service antenatal clinical staff and management.

• Resource use capture template

Local clinical practice guidelines

• A service level guideline and procedure document detailed the model of care, including assessment, brief advice and referral pathways.

• The document was uploaded onto the health service’s policy directory, disseminated by managers to all staff via email and hard copies were placed in staff common areas.

Materials:

• Guideline and procedure document development and provision.

Miscellaneous:

• Electronic dissemination.

Labour time:

• Health district implementation support officer and manager.

• Health service antenatal clinical staff and management.

• Resource use capture template

Electronic prompt and reminder system

• Existing point-of-care and medical record systems used by maternity clinicians were modified to electronically prompt use of the AUDIT-C alcohol screening tool.

• Brief advice scripts were displayed on the point-of-care system based on the woman’s AUDIT-C risk score and prompts and tools for referral to appropriate services.

Materials:

• Computer-based intervention component.

Labour time:

• Health district implementation support officer and manager.

• Health service antenatal clinical staff and management.

• Resource use capture template

Local opinion leaders/champions

• Project-specific Clinical Midwife Educators were appointed to support staff to uptake the model of care and provide support at a one-on-one, team and service level.

• Additional local antenatal clinical leaders were engaged to provide encouragement and demonstrate required behaviours as required.

Labour time:

• Health district implementation support officer.

• Clinical midwife educator (CME) change champion.

• Resource use capture template

Educational meetings and materials

• Training was provided to all antenatal service clinicians via a 30-minute online training module and face-to-face sessions. Clinical Midwife Educators facilitated clinicians completing the online training and coordinate face-to-face training sessions. This included lecture style sessions, interactive, case-study based sessions and one-on-one sessions.

• Clinicians were provided with written resources (hardcopy and electronic) to support the model of care, including standard drink measure charts and point-of care written prompts/reminders (e.g. stickers in charts).

Labour time:

• Health district implementation support officer.

• CME change champion.

• Health service clinical staff.

• Expert clinicians.

Materials:

• Educational tools and resources

• Resource use capture template

• REDCap database

Academic detailing

• Data from both medical records and telephone surveys conducted with women who attended the antenatal services were used to provide feedback on adherence to the agreed model of care.

• The Clinical Midwife Educators visited service teams in their antenatal clinics to provide feedback data and developed action plans to improve adherence.

Labour time:

• Project support officer.

• CME change champion.

• Clinical service staff time.

• Resource use capture template

• REDCap database

Monitoring and accountability

• Antenatal service managers reported, interpreted and monitored performance measures for the model of care.

• These results were disseminated to antenatal service staff through team meetings, emails and other usual communication mechanisms.

• Performance measures were built into the existing monitoring and accountability frameworks for antenatal services.

Labour time:

• Health district implementation support officer.

• Health service antenatal clinical staff and management.

Miscellaneous:

• Electronic dissemination.

• Resource use capture template