How can pregnant women be helped to stop smoking? This was a pilot study of midwife home-based motivational interviewing. Clients were 100 consecutive self-reported smokers booking at clinics in Glasgow from March to May 1997. Smoking guidance is routinely given at booking. In addition, intervention clients received a median of four home-based motivational interviewing sessions from one specially trained midwife. All sessions (n = 171) were audio-taped and interviews (n = 49) from 13 randomly selected clients were transcribed for content analysis. Three 'experts' assessed intervention quality using a recognized rating scale. Cotinine measurement on routine blood samples confirmed self-reported smoking change from late pregnancy telephone interview. Postnatal telephone questionnaire measured client satisfaction. Focus groups of routine midwives explored acceptability, problems and disruption of normal care. Fisher exact, chi 2 and Mann-Whitney tests compared enrolment characteristics. Two-sample t-tests assessed outcome between groups. Motivational interviewing was satisfactory in more than 75% of transcribed interviews. In this pilot study, self-reported smoking at booking (100 of 100 available) corroborated by cotinine (93 of 100) compared with late pregnancy self-reports (intervention 47 of 48; control 49 of 49) and cotinine (intervention 46 of 48; control 47 of 49) showed no significant difference between groups. Tools have been developed to answer the question: 'Can proactive opportunistic home-based motivational interviewing help pregnant smokers reduce their habit?'.
Motivational interviewing is a client centred behavioural therapy for
addictive behaviours. It is an intervention designed to help all addicts,
not just those ready to change. It is therefore suitable for use as an
opportunistic intervention for clients whose main reason for contact may
not be their addiction. A pilot randomized controlled trial of home-based
motivational interviewing by a specially trained midwife to help pregnant
smokers reduce their habit was performed in Glasgow from February 1997 to
January 1998. Did motivational interviewing take place? All 171 counselling
interviews from 48 intervention clients were audio-taped. Forty-nine
interviews from 13 randomly selected clients were transcribed for content
analysis. A rating scale established for feedback to trainee psychologists
was used by three experienced analysts. Thirty-two interviews were scored
independently to validate the rating scale in this setting. More than 75% of
interviews showed satisfactory motivational interviewing. Therapist
utterances were motivational, and client responses included many
self-motivational statements. Few episodes of client resistance were
recorded. Rating took 160 mins per half hour interview. This instrument
provided a valid measure of intervention quality for a randomized
controlled trial. It would not be practical to document process outside
a research environment.
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