Using mixed methods to establish tobacco treatment acceptability from the perspective of clients and clinicians of antenatal substance use services

Abstract

Background Up to 95% of pregnant women with alcohol and other drug (AOD) problems also smoke tobacco. Challenging psychosocial circumstances and a lack of targeted tobacco interventions contribute to low rates of prenatal abstinence and more effective treatment strategies are required. This study explores smoking in pregnant clients of AOD treatment services from a consumer and healthcare provider perspective to examine characteristics of behaviour change and the acceptability of evidence-based tobacco treatment strategies. Outcomes will support the design and implementation of a comprehensive tobacco intervention. Methods A mixed methods triangulated design was used. Thirteen women who smoked and attended antenatal AOD services in New South Wales, Australia, were interviewed and 28 clinicians from the same services were surveyed. Domains including experiences of tobacco smoking in pregnancy, motivators and barriers to cessation and evidence-based strategies to assist cessation during pregnancy were explored. Interviews were analysed using Iterative Categorization, with interpretation guided by Qualitative Description. Online surveys were analysed descriptively. A convergent-parallel mixed methods analysis was performed. Results Women and clinicians agreed that improving baby’s health outcomes was the primary motivation to stop smoking. Negative experiences with nicotine replacement therapy (NRT), financial constraints and maternal contraindications restricted its uptake and effectiveness during pregnancy. Both groups agreed that other AOD use, stopping multiple substances concurrently, difficulty coping with stress and the influence of partners who smoke had the biggest impacts on cessation efforts. Clinicians favoured harm-reduction rather than abstinence-based tobacco interventions and women appeared satisfied with reduction efforts. Both views may influence the attainment of prenatal abstinence-based goals. Although previous evidence suggested the contrary, clinicians were willing to encourage simultaneous cessation of tobacco and other substances. Non-judgmental treatment approaches that provide extra support, education and motivation were important for women. Women and clinicians supported use of NRT despite concerns. Financial incentives, counselling, partner support and offering tobacco treatment with antenatal AOD care were considered acceptable treatment options. Conclusions NRT, incentives, counselling and partner support could be utilized in a tobacco intervention for pregnant women with substance use concerns. Non-judgmental education, motivation, and provision of NRT including instruction for correct use are important considerations.

A Longitudinal Study of Perceptions of the Massachusetts Menthol Ban and Its Impact on Smoking Behaviors among Marginalized Individuals

“…Mixed-method, triangulated designs have been used to support the design and implementation of tobacco interventions in other settings, such as for pregnant women with substance use disorders and smoke-free policies in prisons [31,32]. To our knowledge, our study is the first to use these methods to understand the perceptions of the Massachusetts menthol ban and its impact on smoking behaviors.…”

Tobacco treatment incorporating contingency management, nicotine replacement therapy, and behavioral counseling for pregnant women who use substances: a feasibility trial

“…These should support nicotine withdrawal and accommodate women's competing and complex psychosocial needs, whilst being informed by those with lived and clinical experience ( 18 , 28 , 29 ). The following treatments show potential, particularly when offered in combination, and were presented to clients and clinicians of antenatal facilities that support maternal substance use for feedback ( 30 ).…”

“…NRT use had negative connotations, particularly around side effects and costs of treatment, although both groups conceded its importance in treatment. Service consumers identified that non-judgmental intervention delivery, education, and motivation were essential components of effective counseling ( 30 ).…”