Government supervision on quality of smoking-cessation counselling in midwifery practices: a qualitative exploration

Abstract

BackgroundThe Dutch Healthcare Inspectorate supervises care providers in order to improve quality of care. Recently the inspectorate assessed and promoted the use of a guideline on smoking-cessation counselling in midwifery practices. The supervision programme consisted of an announcement of the enforcement deadline for the guideline and site visits. The purpose of our qualitative study was to identify factors related to guideline adherence after the supervision programme, and investigate whether the programme had helped improve adherence.MethodsWe conducted semi-structured interviews with inspected and non-inspected midwives. Additionally, we studied documents and observed the inspection process. The sampled midwives all work in primary care midwifery practices providing care to pregnant smokers. The questions included the current provision of smoking-cessation counselling, support to the midwife in counselling, recent changes in provision of counselling, reasons for recent changes, knowledge about the supervision programme, and experiences with supervision by the inspectorate.ResultsOur results show that guideline adherence depends on several factors. Awareness and familiarity with the guideline are important, as is outcome expectancy. Additionally, motivation, guideline factors and environment factors were mentioned. Besides these previously documented factors, we found that professional collaboration also determined guideline adherence. Increased collaboration in counselling is associated with greater adherence to the guideline, such as provision of counselling and taking required training. The supervision programme helped improve stop-smoking counselling, by making midwives aware of the counselling and giving them an extrinsic motivation to provide counselling.ConclusionMotivation and environmental aspects were the most important factors related to guideline adherence, and professional environment was added as significant factor. The improved guideline adherence is partly attributable to the supervision programme.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2198-z) contains supplementary material, which is available to authorized users.

Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers

“…It is likely that many HCPs already know the disadvantageous effects of smoking and are generally aware of interventions that may help smokers quit, but perceive themselves to lack the skills required to implement SCC, for example with regard to motivating patients or addressing sensitive subjects. Furthermore, organizational changes may also facilitate SCC, in particular increasing familiarity with the guideline and arranging collaborations for SCC with primary care [63]. Such collaborations were associated with more quit advice, and doubled referral rates among groups of HCPs that were overall less likely to refer.…”

Health providers’ and pregnant women’s perspectives about smoking cessation support: a COM-B analysis of a global systematic review of qualitative studies

“…Stress was detrimental to PW, and in rare instances, HPs encouraged PW to continue smoking to avoid the stress attributed to quitting attempts [ 36 , 38 , 42 , 51 , 48 ]. Communicating the best health advice (IF - education) without making the PW feel guilty, while also trying to maintain a congenial relationship (IF -enablement) with their client, was often challenging for the HPs [ 19 , 22 , 24 , 29 , 30 , 35 , 42 , 48 , 52 , 53 ]. Some HPs overcame this dilemma by recommending cutting down to reduce smoking-related harms rather than quitting, perhaps potentially preserving the relationship with their client (IF – enablement) [ 23 , 24 , 27 , 29 , 33 , 40 , 43 , 46 , 48 , 53 ].…”

“…HPs who had never smoked found it difficult to empathize with their pregnant clients who smoked [ 49 ]. HPs who themselves smoked hardly provided any smoking cessation counseling [ 52 ]. PW corroborated that HPs who smoked did not encourage them to quit or were not insistent enough [ 35 , 52 , 53 ].…”

“…HPs who themselves smoked hardly provided any smoking cessation counseling [ 52 ]. PW corroborated that HPs who smoked did not encourage them to quit or were not insistent enough [ 35 , 52 , 53 ]. For example, PW states this in McLeod, et al [ 53 ] : “My specialist he smokes so (he) does not advocate giving up smoking.”.…”

“…However, the lack of training opportunities was widespread [ 22 , 29 , 48 , 52 ], and some HPs had not had any training at all [ 22 , 29 , 52 ]. These lacunae were specifically in the domains of asking, assessing, and advising about smoking cessation in a way that does not offend or alienate pregnant clients [ 29 ].…”