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

Abstract

Background Smoking cessation in pregnancy has unique challenges. Health providers (HP) may need support to successfully implement smoking cessation care (SCC) for pregnant women (PW). We aimed to synthesize qualitative data about views of HPs and PW on SCC during pregnancy using COM-B (Capability, Opportunity, Motivation, Behaviour) framework. Methods A systematic search of online databases (MEDLINE, EMBASE, PsycINFO and CINAHL) using PRISMA guidelines. PW’s and HPs’ quotes, as well as the authors’ analysis, were extracted and double-coded (30%) using the COM-B framework. Results Thirty-two studies included research from 5 continents: twelve on HPs’ perspectives, 16 on PW’s perspectives, four papers included both. HPs’ capability and motivation were affected by role confusion and a lack of training, time, and resources to provide interventions. HPs acknowledged that advice should be delivered while taking women’s psychological state (capability) and stressors into consideration. Pregnant women’s physical capabilities to quit (e.g., increased metabolism of nicotine and dependence) was seldom addressed due to uncertainty about nicotine replacement therapy (NRT) use in pregnancy. Improving women’s motivation to quit depended on explaining the risks of smoking versus the safety of quit methods. Women considered advice from HPs during antenatal visits as effective, if accompanied by resources, peer support, feedback, and encouragement. Conclusions HPs found it challenging to provide effective SCC due to lack of training, time, and role confusion. The inability to address psychological stress in women and inadequate use of pharmacotherapy were additional barriers. These findings could aid in designing training programs that address HPs’ and PW’s attitudes and supportive campaigns for pregnant smokers.

Isolation, marginalisation and disempowerment – understanding how interactions with health providers can influence smoking cessation in pregnancy

“…In the UK, specialised midwives and a ‘stop smoking in pregnancy service’ with the exclusive aim of working with women to improve smoking cessation rates in pregnancy have been introduced [ 57 ]. As the previous paragraph indicates, health providers already experience time restrictions, overwhelming workloads and work in systems that are not conducive for supporting implementation and monitoring of smoking cessation in pregnancy [ 39 , 51 , 61 ]. Women in SA will continue to be disengaged from smoking cessation if they do not have a supportive health service that utilises contemporary, evidence-based approaches and health providers that have time and capacity to implement them.…”

Perspectives about smoking cessation during pregnancy and beyond of Aboriginal women in Australia: A qualitative analysis using the COM‐B model

“…In a systematic review of pregnant women's views about smoking cessation support received from health professionals, similarly analyzed using the COM‐B model, pregnant women's physical capability to quit (e.g. increased metabolism of nicotine and dependence) was seldom addressed because of uncertainty about NRT use in pregnancy 27,28 . Improving women's motivation to quit depended on health professionals explaining the risks of smoking versus the safety of quitting smoking methods.…”

“…increased metabolism of nicotine and dependence) was seldom addressed because of uncertainty about NRT use in pregnancy. 27,28 Improving women's motivation to quit depended on health professionals explaining the risks of smoking versus the safety of quitting smoking methods. Pregnant women considered advice from health professionals during antenatal visits to be effective, if accompanied by resources, peer support, feedback, and encouragement.…”

“…Pregnant women considered advice from health professionals during antenatal visits to be effective, if accompanied by resources, peer support, feedback, and encouragement. 28 The focus groups were conducted face-to-face by female Aboriginal Research Assistants, enabling direct interaction with the individuals, which was a strength of the study. A further strength was that the age range of the participants was broad and included young women and Elders, both pregnant and non-pregnant women, those who smoked and those who did not, and those with and without a child at home.…”

Benefits of not smoking during pregnancy for non-Aboriginal women and their babies in New South Wales, Australia: a record linkage study

“…Although the risks of smoking during pregnancy are well documented, presentation of the benefits of not smoking may be more beneficial in encouraging pregnant women to stop smoking. A recent review of attitudes towards smoking cessation programs found that healthcare workers found it difficult to communicate health advice on smoking during pregnancy without making the pregnant woman feel guilty and damaging the relationship with the pregnant woman [ 26 ]. The same study reported pregnant women feeling pressured and stigmatized for smoking.…”