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

Abstract

ObjectivesHealth care professionals and the health care environment play a central role in protecting pregnant and post‐partum women and their infants from smoking‐related harms. This study aimed to better understand the health professional's perspective on how interactions between women, health care professionals, and the environment influence how smoking is managed.DesignSemi‐structured interviews and focus groups.MethodsData were from 48 health care staff involved in antenatal or post‐partum care at two UK sites, including midwives, obstetricians, health visitors, GPs, pharmacists, service commissioners, and Stop Smoking Service (SSS) advisors and managers. Thematic analysis was guided by a social–ecological framework (SEF).ResultsThemes were divided across three SEF levels and represented factors connected to the management of smoking in the health care context and the beliefs and behaviour of pregnant or post‐partum smokers. Organizational level: Service reconfigurations, ‘last resort’ nicotine replacement therapy prescribing policies, and non‐mandatory training were largely negative factors. There were mixed views on opt‐out referral pathways and positive views on carbon monoxide monitoring. Interpersonal level: Protection of client–professional relationships often inhibited frank discussions about smoking, and weak interservice relationships affected SSS referral motivation and quality. Individual level: Professionals felt community midwives had primary responsibility for managing smoking, although midwives felt underskilled doing this. Midwives’ perceived priority for addressing smoking was influenced by the demands from unrelated organizational initiatives.ConclusionsOpportunities to improve clinical support for pregnant smokers exist at organizational, interservice, and health care professional levels. Interactions between levels reflect the importance of simultaneously addressing different level‐specific barriers to smoking cessation in pregnancy. Statement of contribution What is already known on this subject? Few health care professionals discuss smoking cessation support with pregnant or post‐partum women.Identified health care professional‐related barriers to supporting pregnant and post‐partum women to stop smoking include deficits in knowledge and confidence, perceived lack of time, and concerns about damaging client relationships.There is currently a gap in understanding regarding the barriers and facilitators to supporting this group and how interactions between the health care environment and health care professionals influence the way smoking is addressed. What does this study add? This study identifies modifiable factors that can influence cessation support delivery to pregnant and post‐partum women.These factors are mapped across organizational, interpersonal, and individual health care professional levels.Service structure, communication pathways, and policies appear to influence what cessation support is offered.Interpersonal and individual factors influence how this support is deliver...

Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals

“…However, qualitative work with pregnant smokers also suggests that negative perceptions around NRT use, the experience of using NRT, and safety concerns are all potentially adherence issues [18]. Recent work with stop smoking practitioners and experts have highlighted opportunities for improvements in behavioural [19] and clinical support [20] regarding smoking cessation in pregnant women. These studies did include some aspects of NRT provision, for example, how at an organisation level, the delayed prescription of NRT to pregnant women could risk client disengagement [20] or that insufficient knowledge around NRT may act as a barrier to smoking cessation [19].…”

“…Recent work with stop smoking practitioners and experts have highlighted opportunities for improvements in behavioural [19] and clinical support [20] regarding smoking cessation in pregnant women. These studies did include some aspects of NRT provision, for example, how at an organisation level, the delayed prescription of NRT to pregnant women could risk client disengagement [20] or that insufficient knowledge around NRT may act as a barrier to smoking cessation [19]. While the latter study has highlighted general knowledge around NRT as a potential area for improved support, what is unclear is which specific topics practitioners feel are important to address and how this may influence treatment adherence.…”

Pregnant Smokers’ Experiences and Opinions of Techniques Aimed to Address Barriers and Facilitators to Smoking Cessation: A Qualitative Study

“…In general, there were positive experiences of both NRT and e-cigarette use amongst the women. However, similar to the beliefs of some health care professionals who are not qualified stop smoking practitioners [28], a few of the women reported safety concerns surrounding the use of e-cigarettes during pregnancy. The fact that e-cigarettes were not perceived to be a substantial enough replacement, particularly relating to stress relief, was also mentioned.…”

“…Work of this type would help to give an indication of any extra support women in this category might need and also what aspects of existing support could be changed to encourage more women to seek help. In relation to accessibility to practitioners, although there are organizational and funding related restrictions on the type of service stop smoking practitioners can provide [13,28], it is recommended that practitioners are flexible in their availability for pregnant clients, which includes being available between scheduled appointments, as much as restrictions allow. Otherwise it may be helpful if the women are signposted to additional options for support, for example online helplines.…”

Physician‐directed smoking cessation using patient “opt‐out” approach in the emergency department: A pilot program

“…23,24 Favorable outcomes have been reported for opt-out smoking cessation programs where bedside consults, referrals, and/or phone follow-up services were provided unless the patient objected in inpatient hospital settings, 25 and within populations of pregnant women. [26][27][28][29][30]…”