Knowledge, attitudes, and practices of fetal alcohol spectrum disorder in health, justice, and education professionals: A systematic review

https://doi.org/10.1016/j.ridd.2022.104354Get rights and content

Highlights

  • Lack of knowledge of FASD can be a barrier to families accessing treatment and support.

  • Across health, education, justice, and social services settings there is poor knowledge and insufficient training.

  • FASD knowledge has been surveyed extensively in the healthcare setting, but surveys are more limited outside of this setting.

  • Continuous surveillance is needed in order to identify and respond to knowledge gaps and changes in practice.

Abstract

Background and Aims

Fetal alcohol spectrum disorder (FASD) is one of the most common forms of developmental disability, and yet, anecdotally, is poorly understood by both the public and professionals across health, justice, education, and social services.

This review aims to understand the knowledge, attitudes, and practices of professionals who work across a range of sectors - specifically health, education and justice - where they may encounter people with FASD, their families and caregivers.

Method

We conducted a systematic search for research using surveys or questionnaires to address knowledge, and attitudes of professionals in health, education, and justice with regards to FASD between 1990 and 2021. Our search consisted of electronic databases (APA PsychInfo, CINAHL, EMBASE, Medline, PubMed, and PAIS Index) and grey literature sources.

Results

Our search yielded 971 results, of which 58 were relevant. The studies surveyed professionals from health (n = 35), education (n = 10), justice (n = 8), social services (n = 1), and multiple settings (n = 4). Most studies were conducted in North America. The areas surveyed included knowledge of FASD, attitudes towards people with FASD, experience with FASD, practices towards people with FASD, and education and training needs.

Conclusions

Knowledge, attitudes, and practices towards FASD have been surveyed extensively in healthcare professionals over the last 30 years, but less so with those working in justice and education sectors. Findings from surveys suggest that although most professionals had some knowledge of the effects of FASD, their knowledge of the specific criteria of Fetal Alcohol Syndrome (FAS) and FASD is poor across most professional groups, including most health professionals. Our review highlights the need to provide training and information across sectors ongoing surveillance to determine where gaps in knowledge are and what resources are needed.

What this paper adds

This study is the first to systematically synthesize knowledge, attitudes, and practices toward FASD across different sectors. Poor knowledge and insufficient training were common. Knowledge, attitudes, and practices about FASD have been surveyed extensively in the healthcare setting, but surveys are more limited outside of this setting. Continuous surveillance is needed to identify and respond to knowledge gaps and changes in practice.

Section snippets

Methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)(Page et al., 2021). The protocol was registered in PROSPERO (CRD42021236908).

Results

Our search of electronic databases yielded 646 records once duplicates were removed, with an additional 285 references identified through grey literature searches. After initial screening by abstract and title, we were left with 178 records. Full-text was available for 177 of the records, which were screened for inclusion. Fifty-seven studies met inclusion criteria. Seven additional studies were identified through backwards citations, giving at total 64 relevant studies; however, six of the

Discussion

Our review found that knowledge, attitudes, and practices towards FASD have been surveyed extensively in healthcare professionals over the last 30 years compared to justice and education settings. Within the healthcare setting, the most surveyed professional group was pediatric providers, who also tended to show the highest rates of knowledge. More recently surveys have been conducted in other settings where professionals are likely to interact with people with FASD outside of healthcare –

Declaration of interest

None.

Acknowledgements

This was an investigator-initiated study funded by a grant from the University of Auckland Faculty Research Development Fund, New Zealand.

References (88)

  • R.J. Zoorob et al.

    Training nurses and nursing students about prevention, diagnoses, and treatment of fetal alcohol spectrum disorders

    Nurse Education in Practice

    (2014)
  • E.L. Abel et al.

    What do physicians know and say about fetal alcohol syndrome: A survey of obstetricians, pediatricians, and family medicine physicians

    Alcoholism: Clinical and Experimental Research

    (1998)
  • Alaska Fetal Alcohol Syndrome Prevention Steering Committee

    Alcohol-related knowledge, attitude, belief and behavior (KABB) surveys of Alaskan health professionals

    Alaska Medicine

    (1995)
  • B.L. Anderson et al.

    Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients' use of alcohol

    Journal of Addiction Medicine

    (2010)
  • K. Arnold et al.

    Fetal alcohol spectrum disorders: Knowledge and screening practices of university hospital medical students and residents

    Journal of Population Therapeutics and Clinical Pharmacology

    (2013)
  • K. Bagley et al.

    How personal perspectives shape health professionals’ perceptions of fetal alcohol spectrum disorder and risk

    International Journal of Environmental Research and Public Health

    (2019)
  • E. Bell et al.

    It’s a shame! Stigma against fetal alcohol spectrum disorder: Examining the ethical implications for public health practices and policies

    Public Health Ethics

    (2015)
  • Binns, W.R. (2000). Fetal alcohol syndrome/fetal alcohol effects: A survey of Alaskan educators. (Doctor of Philosophy...
  • S.M. Birch et al.

    The knowledge of rehabilitation professionals concerning fetal alcohol spectrum disorders

    Occupational Therapy in Health Care

    (2016)
  • Boettcher, L.M. (1995). Alcohol-related birth defects (ARBD): Perspectives of early childhood educators in South...
  • M. Brimacombe et al.

    Fetal alcohol syndrome related knowledge assessment and comparison in New Jersey health professional groups

    Canadian Journal of Clinical Pharmacology

    (2008)
  • J. Brown et al.

    Perceptions of fetal alcohol spectrum disorder (FASD) at a mental health outpatient treatment provider in Minnesota

    International Journal of Environment Research and Public Health

    (2018)
  • L. Burns et al.

    Counting fetal alcohol spectrum disorder in Australia: The evidence and the challenges

    Drug and Alcohol Review

    (2013)
  • L.M. Caley

    Identifying school nurses’ knowledge of fetal alcohol syndrome

    Journal of FAS International

    (2006)
  • L.M. Caley et al.

    What human service professionals know and want to know about fetal alcohol syndrome

    Journal of Population Therapeutics and Clinical Pharmacology

    (2008)
  • Campbell, Y. (2019). Meeting the Educational Needs of Children with Fetal Alcohol Spectrum Disorders (FASDs). (Doctor...
  • L.M. Chiodo et al.

    Prenatal alcohol screening during pregnancy by midwives and nurses

    Alcoholism: Clinical and Experimental Research

    (2019)
  • P. Choate et al.

    Stigma as a dominant discourse in fetal alcohol spectrum disorder

    Advances in Dual Diagnosis

    (2019)
  • J. Chu et al.

    Knowledge, attitudes and practices towards feta alcohol spectrum disorder in New Zealand educators: An online survey

    Journal of Intellectual Disabilities

    (2022)
  • M. Clarke et al.

    Approaches of Canadian providers to the diagnosis of fetal alcohol spectrum disorders

    Journal of FAS International

    (2005)
  • C. Conrad

    Physician awareness and screening for fetal alcohol syndrome

    Journal of Health and Human Services Administration

    (2000)
  • J.L. Cook et al.

    Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan

    Canadian Medical Association Journal

    (2016)
  • P.W. Corrigan et al.

    The public stigma of birth mothers of children with fetal alcohol spectrum disorders

    Alcoholism: Clinical and Experimental Research

    (2017)
  • L.V. Cox et al.

    Knowledge and attitudes of criminal justice professionals in relation to Fetal alcohol spectrum disorder

    Journal of Population Therapeutics and Clinical Pharmacology

    (2008)
  • Dewane, S.L. (2010). Alaskan Physicians' Knowledge, Attitudes, and Behaviors Related to Fetal Alcohol Spectrum...
  • E. Doherty et al.

    Antenatal care for alcohol consumption during pregnancy: pregnant women’s reported receipt of care and associated characteristics

    BMC Pregnancy and Childbirth

    (2019)
  • C.L. Donovan

    Factors predisposing, enabling and reinforcing routine screening of patients for preventing fetal alcohol syndrome: a survey of New Jersey physicians

    Journal of Drug Education

    (1991)
  • Douglas, H., Hammill, J., Hall, W., & Russell, E. (2013). Fetal alcohol spectrum disorders (FASD) within the criminal...
  • E.J. Elliott et al.

    Diagnosis of foetal alcohol syndrome and alcohol use in pregnancy: A survey of paediatricians’ knowledge, attitudes and practice

    Journal of Paediatrics and Child Health

    (2006)
  • E. Espiner et al.

    Describing the experience of Indigenous peoples with prenatal alcohol exposure and FASD: A global review of the literature to inform a Kaupapa Maori study into the experiences of Maori with FASD

    The New Zealand Medical Journal (Online)

    (2022)
  • S.F. Evans et al.

    Fetal alcohol spectrum disorders: Survey of healthcare providers after continuing education

    Journal of Intellectual Disability-Diagnosis and Treatment

    (2014)
  • R. Eyal et al.

    Psychiatry trainees' training and experience in fetal alcohol spectrum disorders

    Academic Psychiatry

    (2011)
  • K. Frances

    Fetal alcohol spectrum disorders: Knowledge and referral pathways in early childhood settings in Western Australia

  • S. Gahagan et al.

    Pediatricians' knowledge, training, and experience in the care of children with fetal alcohol syndrome

    Pediatrics

    (2006)
  • Cited by (11)

    View all citing articles on Scopus
    View full text