A pilot study to establish a randomized trial methodology to test the efficacy of a behavioural intervention

Abstract

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?'.

Why do women continue to smoke in pregnancy?

“…Trials [22][23][24][25][26][27][28][29][30][31][32][33][34] using ''stages of change'' theory were least effective in assisting women to quit. Poor outcomes associated with ''stages of change'' interventions may be explained by the fact that women who smoke during pregnancy use different processing and behavioural coping mechanisms from non-pregnant smokers.…”

Motivational interviews to improve contraceptive use in populations at high risk of unintended pregnancy: a systematic review and meta-analysis

“…The key concepts of motivational interviews are the participant recognising and accepting the need to make changes in their lives; this approach encourages the participants to consider their readiness to change their behaviour [11,12]. For this reason motivational interviews are commonly associated with targeting changing addictive behaviours, [13][14][15][16][17] and they have recently been used with adolescents [18] and pregnant women [19][20][21]. However, the evidence of their effectiveness to improve contraceptive use includes conflicting findings, with some studies reporting an improvement and others reporting no effect.…”

A Test of Motivational Plus Nicotine Replacement Interventions for HIV Positive Smokers

“…Currently, MI as a smoking cessation intervention shows mixed results. While MI shows some promise with adult dependent smokers in primary care (Soria et al 2006) and postpartum women (Thyrian et al 2007), it did not increase quitting among low-income housing residents (Okuyemi et al 2007), cancer patients offered NRT (Wakefield et al 2004), nor pregnant smokers receiving home-based midwife care (Tappin et al 2000). However, these studies (with the exception of Wakefield) used MI alone rather than paired with NRT.…”