Qualitative systematic review: barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth

Abstract

Aim. To explore barriers and facilitators to smoking cessation experienced by women during pregnancy and postpartum by undertaking a synthesis of qualitative studies. Background. The majority of pregnant women are aware that smoking in pregnancy compromises maternal and infant health. Despite this knowledge, quit rates among pregnant women remain low, particularly among women in disadvantaged circumstances; disadvantage also increases the chances of living with a partner who smokes and returning to smoking after birth. A deeper understanding of what hinders and what helps pregnant smokers to quit and remain ex-smokers postpartum is needed. Design. A synthesis of qualitative research using meta-ethnography. Data sources. Five electronic databases (January 1990-May 2013 were searched comprehensively, updating and extending the search for an earlier review to identify qualitative research related to the review's aims. Review methods. Following appraisal, 38 studies reported in 42 papers were included and synthesized following the principles of meta-ethnography. Over 1100 pregnant women were represented, the majority drawn from disadvantaged groups. Results. Four factors were identified that acted both as barriers and facilitators to women's ability to quit smoking in pregnancy and postpartum: psychological well-being, relationships with significant others, changing connections with her baby through and after pregnancy; appraisal of the risk of smoking. Conclusion. The synthesis indicates that barriers and facilitators are not fixed and mutually exclusive categories; instead, they are factors with a latent capacity to help or hinder smoking cessation. For disadvantaged smokers, these factors are more often experienced as barriers than facilitators to quitting.

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

“…Midwives’ tendency to promote reduction over abstinence is also found outside of the United Kingdom (Flemming et al ., 2016; Glover et al ., 2008), although likely reasons for this have not before now been described. Promoting reduction over abstinence can increase ambivalence and reduce motivation to quit for some women (Flemming et al ., 2015; Naughton et al ., 2013), although others report it as supportive as it recognizes the difficulty they have in stopping smoking (Flemming et al ., 2015). …”

“…This view prevails in the United Kingdom despite near universal provision of NRT to pregnant women in the SSSs (Fahy, Cooper, Coleman, Naughton, & Bauld, 2014). It is no surprise, therefore, that pregnant women are uncertain about the safety of NRT in pregnancy (Flemming et al ., 2015) and some perceive the risks of NRT to be equal to tobacco (Naughton et al ., 2013). This may extend to new nicotine‐containing devices such as e‐cigarettes, which, unlike NRT, are not licensed as medicines (Oncken et al ., 2017).…”

“…These include a perceived reticence to discuss smoking, reinforcing and praising cutting down behaviour, and failing to provide practical help or revisit smoking at subsequent appointments (Flemming et al ., 2015; Lendahls, Ohman, Liljestrand, & Hakansson, 2002; Naughton, Eborall, & Sutton, 2013). From the perspective of pregnant or recently pregnant women, therefore, the way health care professionals manage smoking, and health care organizations support their staff to do so, could be improved.…”

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

“…A recent synthesis of 38 studies, including 1100 pregnant women, found living with a partner who smoked increased the likelihood of smoking post birth. Additionally, women whose partners did not challenge their smoking were found to smoke one year post birth [38,39]. Women's smoking issues should be considered alone rather than as a couple [25] as tobacco reduction interventions in pregnancy may cause conflict between a woman and a partner.…”

IRIS – An Internet Based Intervention as a Suitable Path to Addictive Substance Use Prevention and Counselling in Pregnancy? Beneficiary Profiles and User Satisfaction

“…Further effect factors, such as the individual stresses of pregnancy, the functionality of the consumption, the consumption and support behaviour in the social context, financial aspects or the individual degree of motivation additionally influence the utilisation of internet based counselling [33][34][35]. Greater attention should therefore be given to these aspects when designing programmes for the target group of pregnant women consuming addictive substances.…”