Healthcare Professionals’ Beliefs, Attitudes, Knowledge, and Behavior Around Vaping in Pregnancy and Postpartum: A Qualitative Study

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Finding effective ways to help pregnant women quit smoking and maintain long-term abstinence is a public health priority. Electronic cigarettes (i.e., vaping) could be a suitable cessation tool in pregnancy for those who struggle to quit, however, healthcare professionals (HCP) must be informed about these devices to offer appropriate advice. This study used the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF) to explore HCP attitudes towards vaping in pregnancy and postpartum; beliefs about the health risks of vaping; perceived barriers and facilitators of vaping in pregnancy; knowledge of current guidelines and policies; and training needs.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Interviews (n=60) were conducted with midwives (n=17), health visitors (n=10), general practitioners (GPs) (n=15) and stop smoking specialists (n=18) across the UK. Interview transcriptions were analysed thematically using the framework approach and the COM-B.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Discussing vaping as a tool for quitting smoking in pregnancy was prevented by a lack of capability (limited knowledge of ECs, lack of training in smoking cessation); lack of opportunity (restricted by organisational policies and guidelines, lack of time and financial issues impacting on training), and negative social influences (sensationalist media and stigma associated with vaping in pregnancy); and lack of motivation (fear of future litigation and comebacks should adverse effects from vaping arise).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Factors related to capability, opportunity and motivation were identified that influence HCPs attitudes and behaviours towards vaping in pregnancy. Gaps in knowledge and training needs were identified, which could inform the development of targeted vaping training.</jats:p> </jats:sec> <jats:sec> <jats:title>Implications</jats:title> <jats:p>E-cigarettes could be suitable in pregnancy for those struggling to quit smoking. However, healthcare professionals (HCP) must be informed about these devices to offer appropriate advice. These data extend our knowledge of factors influencing HCP attitudes and behaviours towards vaping in pregnancy. Generally, vaping was perceived as safer than cigarettes but a perceived lack of evidence, health and safety risks, dependency and regulation issues were concerning. Considering our findings, greater efforts are needed to ensure HCPs are sufficiently informed about vaping and guidelines available. More importance should be placed on training for all HCPs who have contact with pregnant women.</jats:p> </jats:sec>

‘Why do we have to be the gatekeepers?’ Australian general practitioner’s knowledge, attitudes and prescribing intentions on e-cigarettes as a smoking cessation aid

“…Our ndings are consistent with international literature [13,28,29,[31][32][33][34] that more empirical evidence is needed so GP's can provide accurate and effective advice to patients about the use of e-cigarettes as a smoking cessation treatment. A one-page summary or an infographic of the pro's and con's on e-cigarettes or, a quick snapshot of pertinent information that could be handed out to patients for information was desired.…”

“…Discussions around concerns of e-cigarettes potentially being a gateway to conventional cigarettes and other tobacco products was an issue among our sample of GP's, and of GP's in prior studies [29,33,34]. This impacts the perception of risk that can in uence intentions for clinicians to prescribe a treatment.…”

Assessing and addressing vulnerability in pregnancy: General practitioners perceived barriers and facilitators - a qualitative interview study

“…It is derived from an integration of 33 theories and 128 constructs from behavioral theory, resulting in 14 theoretical domains useful for categorizing barriers and facilitators to specific behaviors [ 38 , 40 , 41 ]. TDF has been validated to facilitate research into implementation problems [ 42 ], and it has been used in empirical studies exploring the barriers of GPs and other health care professionals when implementing interventions in clinical areas—such as preconception care [ 43 ], weight management and smoking cessation during pregnancy [ 44 – 46 ] and the delivery of healthy kids check [ 47 ]. A codebook was developed accommodating the TDF domains for the concept of assessing and addressing vulnerability (See Appendix 3 ).…”

GP knowledge, attitudes, beliefs, and practices surrounding the prescription of e-cigarettes for smoking cessation: a protocol for a mixed-method systematic review

“… 19 , 37 This suggests that there is knowledge deficit around e-cigarettes for smoking cessation, and further research and guidance is needed to provide patients with correct information regarding e-cigarettes as a smoking cessation aid in primary care settings. 16 – 19 , 37 , 38 , 41 , 43 – 46 …”