Strong Spirit Strong Future campaign in Western Australia

Cover FASD Forum Report

The Strong Spirit Strong Future- Promoting Healthy Women and Pregnancies project in Western Australia started in 2010 and will continue until June 2014.

This FASD prevention project has included the development of culturally secure resources, community awareness media campaign, and training and education for health professionals and other workers.

You can take a look at several of the video and radio advertisements that have been created as part of this project by visiting the Drug and Alcohol Office of Western Australia website. Target audiences have included women, men, and the general community and have been designed for rural and urban audiences.

The Strong Spirit, Strong Future campaign is part of the larger Western Australian Alcohol Think Again campaign which aims to reduce alcohol-related harm by changing the drinking culture in Western Australia.

The campaign builds upon the Aboriginal Inner Spirit Model (Ngarlu Assessment Model) developed by Joesph ‘Nipper’ Roe, who belonged to the Karajarri and Yawuru people.

“Strong Spirit Strong Mind promotes the uniqueness of Aboriginal culture as a central strength in guiding efforts to manage and reduce alcohol and other-drug related harm in Aboriginal communities.”

Sssm-Inner-Spirit-Model

For more on FASD prevention with indigenous communities in Western Australia, see earlier posts:

In Western Australia, 70% of mothers who had a child diagnosed with FASD did not have an alcohol-related diagnosis recorded during pregnancy

Image credit: Malcolm Browne, via flickr
Image credit: Malcolm Browne, via flickr

A recent study by Colleen O’Leary and colleagues in Western Australia explored trends in alcohol-use disorders in pregnant women between 1985 and 2006.

Rather than focusing on the prevalence of FASD in children, the researchers chose to focus on mothers of children with a diagnosis of FASD and determine whether these mothers had their alcohol use formally recognized by health care providers or whether they received health services to address alcohol misuse. They also examined alcohol-related diagnoses (e.g., heavy alcohol consumption) to gain a sense of whether alcohol use and misuse was being addressed by health care providers before, after, and during pregnancy.

This population-based cohort study using linked, longitudinal, health, mental health, and drug and alcohol data sets. Overall, 5839 non-Aboriginal mothers and 2583 Aboriginal gave birth between 1985 and 2006 who had an alcohol-related diagnosis recorded on one or more of the hospital morbidity, mental health outpatients, or drug and alcohol data sets. This group of women was compared with another group of women without an alcohol-related diagnosis and who were matched on maternal age, year of birth of offspring, and Aboriginal status.

The researchers found a substantial increase in the proportion of births with an alcohol diagnosis recorded during pregnancy across the 22 years for all mothers. For both non-Aboriginal and Aboriginal mothers, around 80% of the pregnancy alcohol diagnoses were recorded for births occurring from 1995 to 2006.

This trend may be related to changes in knowledge and awareness regarding the effects of alcohol use during pregnancy. In 2001, alcohol and pregnancy was included for the first time in the Australian national policy agenda. This resulted in considerable debate and, in 2009, guidelines regarding alcohol use during pregnancy shifted to promote abstinence.

One of the most interesting findings from this study was that the majority (70%) of mothers who had a child diagnosed with FAS did not have an alcohol diagnosis recorded during pregnancy. While there are a wide range of possible reasons for this (e.g., health care providers not routinely discussing alcohol use with women, women not feeling comfortable disclosing their alcohol use, general perception that alcohol use is not a major concern), it does suggest that there are many pregnant women who are not receiving support and information regarding their alcohol use and are not being referred to other services and supports. This raises questions about the different ways that health care providers, program planners, and policy analysts can be working to create a more responsive and supportive system to women with alcohol misuse concerns.

For more on FASD prevention in Western Australia, see earlier posts:

 References

Alati, T. (2013). In Western Australia, 70% of mothers of babies with fetal alcohol syndrome did not have an alcohol-related diagnosis recorded during pregnancy. Evidence-based Nursing. doi: 10.1136/eb-2013-101456

O’Leary, C., Halliday, J., Bartu, A., D’Antoine, H., and Bower, C. (2013). Alcohol-use disorders during and within 1 year of pregnancy: a population-based cohort study 1985–2006. BJOG, 120: 744–53.

Developing and Testing Alcohol and Pregnancy Campaign Messages: Exploring What Works with Women

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An article published by Kathryn E. France and colleagues in the journal Substance Use & Misuse looks at the development and testing of advertising concepts for a campaign to promote abstinence from alcohol during pregnancy in Western Australia.

France and colleagues conducted a series of nine focus groups with women on beliefs and attitudes on alcohol use during pregnancy and motivations for behavior change and gathered feedback on four television concepts that used different types of messaging.

Some of the key findings from the study include:

  • Women’s motivations for stopping alcohol use during pregnancy included, but were much broader than, a desire to protect their baby from harm
  • Messages could either aim to emphasize that the negative outcomes, experiences, or feelings could be reduced or avoided and/or that positive outcomes, experiences, or feelings could be obtained or maintained if women abstained from alcohol during pregnancy (e.g., wanting to minimize a generalized fear that something could go wrong or wanting to believe they were in control and doing the best that they could to support the health of the pregnancy and the baby)
  • In this particular study, the most effective message/tested ad concept was one that appealed to negative emotions, suggesting that fear appeals can be more effective than positive messages
  • It might be useful for campaigns to also include positive messages (e.g., a display of social support and acceptance for a pregnant women) abstaining from alcohol in conjunction with a threat-based message
  • Study participants also appreciated specific strategies for avoiding alcohol during social situations.

This study supports previous research showing that fear-based messaging can be effective if the behaviour that is being promoted is achievable by the viewer, i.e., women who drink alcohol in general. Fear or threat-based messaging promoting abstinence is not helpful for women with alcohol problems.

The authors also comment on the importance of being honest and factual about the limits of research on alcohol during pregnancy. Most women believed the public health guidelines that alcohol should be avoided during pregnancy, but questioned whether light drinking was a major concern.

“Credibility of the message was enhanced by acknowledging uncertainty about the risk to the fetus with low to moderate alcohol exposure. Rather than undermine an abstinence-based message, this information served as a clear rationale for the recommendation. An honest and scientific framing of the message and delivery by an expert source were also shown to minimize counterargument and strengthen the message’s persuasiveness.” (p. 8)

For more on this topic, see earlier posts:

Reference

France, K. (2011). Creating Persuasive Messages to Promote Abstinence from Alcohol During Pregnancy. Theses: Doctorates and Masters. Paper 413. http://ro.ecu.edu.au/theses/413

France, K., Donovan, R.J., Henley, N., Bower, C., Elliott, E.J. et al. (2013). Promoting Abstinence From Alcohol During Pregnancy: Implications From Formative Research. Substance Use & Misuse, Early Online:1–13.  DOI: 10.3109/10826084.2013.800118