Diagramas de Casos de uso

Participants in the study were women and partners of women who had given birth in the last 12 months. Further inclusion criteria included living in either Merseyside or Örebro County and good command of English or Swedish. All partners who took part in the survey were male.

Merseyside

In Merseyside, 142 parents completed the questionnaire, either in paper version or an online version. A total of 13 questionnaires were excluded due to; participant lived in an area other than Merseyside (n=8), participant was still pregnant (n=1), baby was older than 12 months (n=4). This left a total sample of 129 parents for analysis (see table X for participant characteristics).

The initial recruitment strategy aimed to get a representative sample from the Merseyside area, whereby all children’s centres in the county were approached and asked to support the study by either distributing questionnaires through activities or allowing researcher access to distribute questionnaires. This approach, rather going through the National Health Service (NHS) was a pragmatic decision in relation to time and resources, as a study using NHS patients would require additional ethical approval. In total, 15 children’s centres agreed to support the study, however only 2% of questionnaires that were sent out

to the centres for distribution by staff were returned. For questionnaires that were distributed in person in waiting rooms of children’s centres, 39% of approached parents returned a completed questionnaire either in person or by sending it through post at a later time. To complement the paper-based survey, due to low response rate and difficulties with engaging with a larger number of services, an online version was created, using Bristol Online Surveys (Bristol Online Surveys, n.d). The online version constituted the majority of the final number of completed surveys (61%). Recruitment and data collection was carried out between July 2013 and March 2014.

Approval to collect data at the above mentioned services was obtained from coordinators at the individual children’s centres, forum administrators, and administrators of for example parent support groups on Facebook. Parents were approached on the basis that they had given birth in the last 12 months, or if their partner had given birth in that time period. Participants were provided brief information of the study either verbally or in conjunction with a link to the online survey. If participants expressed interest in taking part in the survey, or clicked on the link for the online survey, they were provided a participant information sheet (Appendix B), which outlined the details of the study, that their data would be kept confidential, and that they could withdraw their participation at any time. In the online survey participants were asked to provide a unique code (made up by their own and their partner’s initials and year of birth) and each paper copy of the survey had a unique code. Withdrawal from the study was therefore made possible if the participant provided their code, however no respondent withdrew their participation. A completed questionnaire was regarded as the participant having given consent to take part by submitting the survey. Data was collected from July 2013 to March 2014.

Örebro County

In Örebro County questionnaires were distributed through 25 of the 26 child health care centres, which are based within local GP practices. One centre was removed from the study as the children’s nurse was unable to distribute the questionnaires due to heavy workload. In total, 218 parents completed (see table X for participant characteristics) the questionnaire which corresponded to a response rate of 25.1%, ranging from 0% to 80% at individual clinics. No data were collected on the characteristics of non-responders. All parents who attended the child health care for their five-month routine check-up with the child health care nurse were approached and provided verbal brief information. Parents who indicated interest in taking part in the study were provided two participant information

sheets, two questionnaires, and two pre-stamped envelopes to send the survey back individually. The same principles regarding consent were followed as in Merseyside (see above). Recruitment and data collection was carried out from September 2014 to March 2015. In Sweden a good collaboration was already established between the collaborating institution -Örebro University- and the regional child health care system. This facilitated setting up recruitment through the child healthcare centres with help from the regional head of child health care. Furthermore, the process for ethical approval from the regional ethical review board did not require additional approval. Given that this arrangement was possible, a Swedish online version was not created due to time limitations.

Participants

Descriptive statistics for the sample (N=347; median age: 32.0, 37% English, 63% Swedish) are presented in Table 5. For the 342 parents who provided their age, Mann Whitney U test indicated that there was no significant difference in age between English parents (Mdn=32.0) and Swedish parents (Mdn=32.0), U = 13089.50, z = -.064, p = .52. The relationship variable was divided into three categories; married, de facto (in a relationship but not married), and single/divorced/other. The majority of English parents were married (70%) which was significantly higher than among Swedish parents (46%), where more than half were living in de facto relationships (52%) which was higher than among English parents (26%), p < 0.001. Significantly more parents in the English sample were first-time parents (70%) compared to the Swedish sample (48%), p < 0.001.

The majority of pregnancies in both samples were planned (82%). Education was dichotomised into less than university degree level and having a university degree (undergraduate or higher). There was no significant difference in the proportion with a university degree in England (63%) and Sweden (60%). There was no significant difference between proportion of parents who were in employment in the English (91%) and Swedish sample (92%).

Table 5. Participant characteristics for Study I (N=347), n (%) England (n=129) Sweden (n =218) Total (N=347) p-value Gender Female 103 (80) 128 (59) 321 (67) Male 26 (20) 90 (41) 116 (33) Age, Mdn (min-max) 32.0 (21–54) 32.0 (21–52) 32.0 (21–54) 0.523 <25 10 (8) 21 (10) 31 (9) 0.643 26-35 94 (74) 149 (69) 243 (71) >36 23 (18) 45 (21) 68 (20) Missing 2 3 5 Education 0.582 < University degree 46 (37) 86 (40) 132 (39) University degree 79 (63) 130 (60) 209 (61) Missing 4 2 6 Relationship status <.001 Married/Civil part. 88 (70) 100 (46) 188 (55) De facto relationship 33 (26) 112 (52) 145 (42) Single/Divorced/Other 5 (4) 5 (2) 10 (3) Missing 3 1 4 First-time parent <.001 Yes 90 (70) 102 (48) 192 (56) No 38 (30) 112 (52) 150 (44) Missing 1 4 5 Employment status 0.849 In employment 116 (92) 201 (93) 317 (92) Student/unempl/other 10 (8) 16 (7) 26 (8) Missing 3 1 4 Planned pregnancy 0.961 Yes 105 (82) 176 (82) 281 (82) No 23 (18) 38 (18) 61 (18) Missing 1 4 5

Coding of consumption variables

Heavy episodic drinking (HED) – intake of more than 60g at typical (Q9) or special drinking

occasions (Q11) before pregnancy was coded as HED (=1), whereas consumption of less than 60g per drinking occasion was coded as not HED (=0).

Any alcohol use before pregnancy – any alcohol consumption at typical (Q9) or special occasions

(Q11) before pregnancy was coded as any alcohol use before pregnancy (=1), whereas no drinking at either drinking occasion was coded as no alcohol use before pregnancy (=0).

Any alcohol use before pregnancy – any alcohol consumption at typical (Q13, Q17, Q21) or special

occasions (Q15, 19, Q23) before pregnancy was coded as any alcohol use before pregnancy (=1), whereas no drinking at either drinking occasion was coded as no alcohol use before pregnancy (=0).