Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Abstract

Background: Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women's significant others (SOs) and support from health-care professionals (HPs). Objectives: To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. Design: Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women's, SOs' and HPs' views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social-ecological framework (conceptualises behaviour as an outcome of individuals' interactions with environment); and (4) identification of new/ improved interventions for future testing. Setting: Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). Participants: Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women's SOs and 28 individual/group interviews with 48 HPs were conducted. Main outcome measures: The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. Results: Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social-ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners' emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural s...

Awareness of Pregnant Women About Routine Applied Screening Tests and Supportive Treatments in a University Hospital

“…In studies conducted in England and Scotland, it was reported that one in four women smoked before or during pregnancy, and one in eight women continued smoking during their pregnancy. In a study conducted in Romania, it was reported that 30% of the interviewed mothers were smoking before pregnancy and that 43.3% of them continued smoking during pregnancy (13,14). In a study conducted with 513 pregnant women in Italy, 22.3% of the participants continued to smoke during their pregnancy and claimed that they continued smoking during their pregnancy because they received very little information about this subject during their examination (15).…”

Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting

“…Fifteen papers (Table 5) were included on predictors of smoking or barriers to cessation for women [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82]. Barriers and predictors of smoking cessation during pregnancy can be broadly divided into factors operating at the health provider (HP) level, social level and individual level.…”

“…Bauld et al reviewed 55 studies and found that partners' support and the role of smoking within the relationship were important to quitting [78]. Graham et al highlighted how complex circumstances during pregnancy acted as a barrier to quitting smoking [76].…”

Parent-Carer Education: Reducing the Risks for Neonatal and Infant Mortality

“…Barriers to smoking cessation are multi-fold and may exceed support pathways. In an NIHR HTA assessment of these [45], partners' support, willingness to change smoking behaviour and the smoking dynamics within relationships mattered, and delivery of information is a key barrier than can potentially be overcome with the appropriate educational drives. At the same time, it is important to note that up to 50% of women who stop smoking during their pregnancy resume within 6 months after birth [46].…”