Improving implementation of the smoking cessation guidelines with pregnant women: How to support clinicians?

Longman, Jo; Adams, Catherine; Johnston, Jennifer J.; Passey, Megan

doi:10.1016/j.midw.2017.12.016

Cited by 38 publications

(95 citation statements)

References 50 publications

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“…The inclusion of these mandatory fields in the clinical information system also explains the lack of variability in response to these questions and highlights the importance of electronic information systems in providing prompts for clinical activity [26]. .The finding that smoking is more frequently addressed at the initial visit than at subsequent visits is consistent with multiple other studies with both midwives and obstetricians [12,22,24,27,28]. Offering personalised support for cessation repeatedly throughout pregnancy is valuable as it provides a consistent message for women that midwives are concerned about them and their smoking [29,30].…”

Section: Discussionsupporting

confidence: 73%

“…The first factor identified in the analysis of barriers was 'Capability', which included all the knowledge, skills and confidence (beliefs about capabilities) items. Participants reported poorer knowledge, skills and confidence related to Assisting than Assessing, and more commonly agreed with knowledge statements than with those for skills and confidenceconsistent with both their reported behaviour and other research [12,21,22]. Importantly, the 'Capability' factor was significantly associated with 'Helping' women, and thus, ascertaining the items in 'Capability' with lesser agreement (skills, confidence and adequate training) helps to identify potential components for interventions.…”

Section: Discussionmentioning

confidence: 81%

“…There was little disagreement with any of the three items in this factor, however, the item about placing a high priority on smoking cessation was least well supported. Qualitative research has identified that a perceived lack of time to address smoking, combined with a perception that smoking was a 'private' issue resulted in smoking cessation being a low priority in some circumstances [12]. One approach to persuading clinicians to prioritise smoking cessation is to 'reframe' their perception of smoking by drawing parallels with other conditions and their approach to them [14].…”

Section: Discussionmentioning

confidence: 99%

“…In New South Wales (NSW), only 46% of women who smoked in pregnancy recalled being told about quitting programs [11]. Qualitative research has confirmed gaps in care, especially with Assisting and Arranging follow-up [12]. The failure to deliver smoking cessation support (SCS) is a critical missed opportunity to support cessation.…”

Section: Introductionmentioning

confidence: 99%

“…This process, including the use of the TDF, facilitates mapping barriers to intervention components using the BCW [14]. Combined with qualitative data already published [12], these results have been mapped to specific, tailored intervention components and behaviour change techniques to form a comprehensive intervention to improve implementation of SCS.…”

mentioning

confidence: 99%

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Factors associated with provision of smoking cessation support to pregnant women – a cross-sectional survey of midwives in New South Wales, Australia

Passey

Longman

Adams

et al. 2020

BMC Pregnancy Childbirth

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Background:Smoking is the most important preventable cause of adverse pregnancy outcomes, but provision of smoking cessation support (SCS) to pregnant women is poor. We examined the association between midwives' implementation of SCS (5As -Ask, Advise, Assess, Assist, Arrange follow-up) and reported barriers/enablers to implementation. Methods: On-line anonymous survey of midwives providing antenatal care in New South Wales (NSW), Australia, assessing provision of the 5As and barriers/enablers to their implementation, using the Theoretical Domains Framework (TDF). Factor analyses identified constructs underlying the 5As; and barriers/enablers. Multivariate general linear models examined relationships between the barrier/enabler factors and the 5As factors. Results: Of 750 midwives invited, 150 (20%) participated. Respondents more commonly reported Asking and Assessing than Advising, Assisting, or Arranging follow-up (e.g. 77% always Ask smoking status; 17% always Arrange follow-up). Three 5As factors were identified-'Helping', 'Assessing quitting' and 'Assessing dependence'. Responses to barrier/enabler items showed greater knowledge, skills, intentions, and confidence with Assessment than Assisting; endorsement for SCS as a priority and part of midwives' professional role; and gaps in training and organisational support for SCS. Nine barrier/enabler factors were identified. Of these, the factors of 'Capability' (knowledge, skills, confidence); 'Work Environment' (service has resources, capacity, champions and values SCS) and 'Personal priority' (part of role and a priority) predicted 'Helping'. Conclusion: The TDF enabled systematic identification of barriers to providing SCS, and the multivariate models identified key contributors to poor implementation. Combined with qualitative data, these results have been mapped to intervention components to develop a comprehensive intervention to improve SCS.

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