Making sense of the challenge of smoking cessation during pregnancy: a phenomenographic approach

Abstract

In general, most women are familiar with the need to stop smoking when they are pregnant. In spite of this, many women find it difficult to stop. Using a phenomenographic approach, this study explored Swedish pregnant and post-pregnant women's ways of making sense of smoking during pregnancy. A total of 17 women who either smoked throughout pregnancy or stopped smoking during pregnancy were interviewed. Five different story types of how they are making sense of smoking during pregnancy were identified: smoking can be justified; will stop later; my smoking might hurt the baby; smoking is just given up; smoking must be taken charge of. Based on the study it is argued that the approach used in health education in relation to smoking cessation in antenatal care needs to move from information transfer and advice-giving to the creation of a dialogue. The starting point should be the woman's knowledge, concerns, rationalizations and prejudices. A model is suggested in which a woman may move in a space on three axes depending on life encounters, dialogue and reflections on meaning. The goal in health education would be to encourage movement along three axes: 'increase of self-efficacy towards control', 'increase awareness by reflection on meaning of the smoking issue' and 'avoidance of defense of the smoking behavior'.

Exploring the barriers of quitting smoking during pregnancy: A systematic review of qualitative studies

“…13 A further study that demonstrated how women make sense of their smoking during pregnancy, concluded that women feel ashamed of their smoking and try to justify their smoking behaviour. 1,16 However, despite these negative emotions, smoking was still depicted as an essential daily coping mechanism. Furthermore, women lacked self confidence regarding their ability to maintain abstinence postnatally, which consequently decreased their motivation to attempt to quit during pregnancy.…”

“…1,12,13 Barriers to cessation, attitudes to nicotine replacement therapy (NRT) and perception of the counselling provided by health professionals were examined. 13,16 Cessation service provision was viewed negatively by women as they had previously been dealt with in a judgemental manner by health professionals and were therefore reluctant to discuss their current smoking behaviour.…”

“…13,16 Cessation service provision was viewed negatively by women as they had previously been dealt with in a judgemental manner by health professionals and were therefore reluctant to discuss their current smoking behaviour. 1,13,16 A further study explored the reasons why women quit during pregnancy and the factors that were involved in relapsing. 2 Successful quitters were found to be women who had a strong sense of moral identity and had a more stable living environment.…”

“…1,2 For example, Haslam, Draper and Goyder 3 found that half of the women they interviewed could state without any prompting two or more health risks including breathing problems, congenital malformations, low birth weight, premature birth, low IQ and circulatory problems. Research demonstrating the associated risks are widely documented.…”

“…8 Despite existing interventions, pregnant women remain difficult to motivate and support in the quitting process, with research illustrating that only approximately 30% of pregnant smokers quit. 1,9 Women who attempt to change their smoking behaviours during pregnancy encounter numerous barriers.…”