Practitioners’ Views on Nicotine Replacement Therapy in Pregnancy during Lapse and for Harm Reduction: A Qualitative Study

Abstract

Many countries, including the UK, recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy. However, adherence to NRT is generally low, smoking lapse or relapse is common and using NRT to reduce the harm from the number of cigarettes smoked is only advocated in non-pregnant smokers. Two focus groups were conducted with 13 professionals involved in antenatal stop smoking services (SSS). The data were analysed thematically. Two themes were extracted that describe health professionals’ attitudes towards using NRT either during lapses or to reduce smoking in women who cannot quit (harm reduction). These are presented around a social–ecological framework describing three hierarchical levels of influence within smoking cessation support: (1) Organizational: providing NRT during lapses could be expensive for SSS though harm reduction could result in services helping a wider range of clients. (2) Interpersonal: participants felt using NRT for harm reduction was not compatible with cessation-orientated messages practitioners conveyed to clients. (3) Individual: practitioners’ advice regarding using NRT during smoking lapses varied; many were generally uncomfortable about concurrent smoking and NRT use and had strong reservations about recommending NRT when smoking during all but the briefest lapses. Further evidence is required to guide policy and practice.

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

“…Studies of vaping and health outcomes in pregnancy have been equivocal, due to small sample sizes 21,22 . There are also concerns and misperceptions around using nicotine in any form during pregnancy 23 . The controversy surrounding vaping may impact on HCP attitudes, thus influencing recommendations for their patients.…”

Agreement and Disparities between Women and Stop-Smoking Specialists about How to Promote Adherence to Nicotine Replacement Therapy in Pregnancy

“…The women in our study seemed particularly interested in knowing what to do in a smoking lapse, but specialists had strong concerns about recommending continued NRT use in this situation. Identifying what constitutes a lapse, as opposed to a full relapse, and the appropriate management with NRT in this population, are matters that warrant further research [ 26 ].…”

“…Importantly, concerns about safety, nicotine intake, and nicotine dependency are often heightened in the context of combination NRT (using a patch plus a fast-acting NRT product) [ 23 ]. Healthcare professionals who deliver smoking-cessation advice can also be cautious about NRT use in pregnancy, especially when it comes to discussing topics such as safety [ 24 , 25 ] or use during a smoking lapse [ 26 ]. High-quality evidence on NRT use in pregnancy, and what works to help women use it properly, is therefore needed.…”

Development of “Baby, Me, & NRT”: A Behavioral Intervention to Improve the Effectiveness of Nicotine Replacement Therapy in Pregnancy

“…Further qualitative research was carried out to help decide on intervention delivery modes, design objectives and content. First, we held an in-person expert advisory meeting 26 , 27 to build consensus and consolidate knowledge acquired from the formative research and mapping exercise. The research team then met to discuss potential delivery modes and which might work best for each of the intervention objectives.…”

“…Next, 10 interviews with pregnant people who had declined NRT or struggled to quit smoking when using it and a focus group with six stop smoking experts were conducted. 25 , 27 The format between the two slightly differed, but both groups were presented with potential intervention content and were asked to share their thoughts on persuasiveness and acceptability. Participants were also asked for their views on how the intervention might be delivered and important design features for each of the delivery modes.…”