How should midwives discuss smoking behaviour in pregnancy with women of low educational attainment?

Arborelius, Elisabeth; Nyberg, Karin

doi:10.1016/s0266-6138(97)80008-3

Cited by 23 publications

(44 citation statements)

References 19 publications

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“…Women and partners in the review studies talked about the benefts of a smoking break by themselves or with others. 111,115,120,[122][123][124][125] This was mirrored in our interviews. Smoking was a key part of daily routine, relieving boredom and providing a welcome pause and time away from other children, an unemployed partner or other members of the household.…”

Section: Stress and Enjoymentsupporting

confidence: 57%

“…HPs who were 'facilitating' were described as friendly, non-judgemental and applying a positive and systematic approach to supporting cessation. 115,116,122,123,136 In our interviews with women, there was a strong focus on the midwife or, for those who accessed cessation services, the SSS advisor. Women often described their midwife as supportive and reassuring, and they viewed this as an important and positive relationship.…”

Section: Barriers From Partners and Significant Othersmentioning

confidence: 99%

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Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Bauld

Graham

Sinclair

et al. 2017

Health Technol Assess

111

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Background: Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women's significant others (SOs) and support from health-care professionals (HPs). Objectives: To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. Design: Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women's, SOs' and HPs' views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social-ecological framework (conceptualises behaviour as an outcome of individuals' interactions with environment); and (4) identification of new/ improved interventions for future testing. Setting: Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). Participants: Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women's SOs and 28 individual/group interviews with 48 HPs were conducted. Main outcome measures: The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. Results: Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social-ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners' emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural s...

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Section: Stress and Enjoymentsupporting

confidence: 57%

Section: Barriers From Partners and Significant Othersmentioning

confidence: 99%

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Bauld

Graham

Sinclair

et al. 2017

Health Technol Assess

111

View full text Add to dashboard Cite

show abstract

“…While some health care professionals view such prompts as promoting a prescriptive rather than sensitive approach to discussing smoking (Flemming et al ., 2016), our participants indicated that improved prompts could help encourage and inform smoking discussions. Integrating agreed scripts to aid discussion around smoking could help professionals present a clear and comprehensive picture of the risks and avoid the common practice of raising only certain risks to minimize upset, which is largely at odds with the information preferences of pregnant smokers (Arborelius & Nyberg, 1997; Lendahls et al ., 2002). Health care professionals have reported interest in scripts for discussing smoking with pregnant women (Colomar et al ., 2015), and a midwife‐delivered standardized ‘risk perception’ intervention has already been implemented in North East England as part of an opt‐out referral pathway (‘BabyClear’) (Bell et al ., 2017).…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to smoking cessation in pregnancy and in the post‐partum period: The health care professionals’ perspective

Naughton

Hopewell

Sinclair

et al. 2018

British J Health Psychol

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ObjectivesHealth care professionals and the health care environment play a central role in protecting pregnant and post‐partum women and their infants from smoking‐related harms. This study aimed to better understand the health professional's perspective on how interactions between women, health care professionals, and the environment influence how smoking is managed.DesignSemi‐structured interviews and focus groups.MethodsData were from 48 health care staff involved in antenatal or post‐partum care at two UK sites, including midwives, obstetricians, health visitors, GPs, pharmacists, service commissioners, and Stop Smoking Service (SSS) advisors and managers. Thematic analysis was guided by a social–ecological framework (SEF).ResultsThemes were divided across three SEF levels and represented factors connected to the management of smoking in the health care context and the beliefs and behaviour of pregnant or post‐partum smokers. Organizational level: Service reconfigurations, ‘last resort’ nicotine replacement therapy prescribing policies, and non‐mandatory training were largely negative factors. There were mixed views on opt‐out referral pathways and positive views on carbon monoxide monitoring. Interpersonal level: Protection of client–professional relationships often inhibited frank discussions about smoking, and weak interservice relationships affected SSS referral motivation and quality. Individual level: Professionals felt community midwives had primary responsibility for managing smoking, although midwives felt underskilled doing this. Midwives’ perceived priority for addressing smoking was influenced by the demands from unrelated organizational initiatives.ConclusionsOpportunities to improve clinical support for pregnant smokers exist at organizational, interservice, and health care professional levels. Interactions between levels reflect the importance of simultaneously addressing different level‐specific barriers to smoking cessation in pregnancy. Statement of contribution What is already known on this subject? Few health care professionals discuss smoking cessation support with pregnant or post‐partum women.Identified health care professional‐related barriers to supporting pregnant and post‐partum women to stop smoking include deficits in knowledge and confidence, perceived lack of time, and concerns about damaging client relationships.There is currently a gap in understanding regarding the barriers and facilitators to supporting this group and how interactions between the health care environment and health care professionals influence the way smoking is addressed. What does this study add? This study identifies modifiable factors that can influence cessation support delivery to pregnant and post‐partum women.These factors are mapped across organizational, interpersonal, and individual health care professional levels.Service structure, communication pathways, and policies appear to influence what cessation support is offered.Interpersonal and individual factors influence how this support is deliver...

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“…Anderson (2002), in a focus group study of pregnant women smokers in the USA, reports the perception that there had not been "a thorough attempt to explain what smoking was doing to the baby, how quitting lowers risks, and how to go about trying to quit". In an interview study (Arborelius & Nyberg, 1997) nine of the thirteen Swedish women stated that they would have given up if they had been given proof that smoking was dangerous or that the baby would be harmed. McCurry et al (2002) report participants' perception that they had been advised rather than strongly persuaded to give up smoking.…”

Section: The Provision Of Informationmentioning

confidence: 99%

“…Also, some reported that they had been insulted by the professional's condescending tone, and had left the consultation feeling resentful. Arborelius and Nyberg (1997) similarly describe the perception that a midwife should not be authoritarian, and should not exhort, pressure or nag.…”

Section: The Provision Of Informationmentioning

confidence: 99%

Factors relating to the uptake of interventions for smoking cessation among pregnant women: A systematic review and qualitative synthesis

Baxter

Everson-Hock

Messina

et al. 2010

Nicotine & Tobacco Research

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How should midwives discuss smoking behaviour in pregnancy with women of low educational attainment?

Cited by 23 publications

References 19 publications

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Barriers and facilitators to smoking cessation in pregnancy and in the post‐partum period: The health care professionals’ perspective

Factors relating to the uptake of interventions for smoking cessation among pregnant women: A systematic review and qualitative synthesis

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