Factors relating to the uptake of interventions for smoking cessation among pregnant women: A systematic review and qualitative synthesis

Baxter, Susan; Everson-Hock, Emma; Messina, John; Guillaume, Louise; Burrows, Julia; Goyder, Elizabeth

doi:10.1093/ntr/ntq072

Cited by 50 publications

(74 citation statements)

References 29 publications

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“…Reviews in which health professionals' and women's perspectives were given equivalent weight and the findings could be distinguished, for example the study by Baxter and colleagues 222 on smoking cessation, were included. Similarly, in a review that included quantitative and qualitative studies relating to the perspectives of adolescents on breastfeeding, only the findings from the qualitative studies were included.…”

Section: Exclusion Criteriamentioning

confidence: 99%

“…Study characteristics Three reviews, 222,225,226 which included women's accounts of the barriers to and facilitators of smoking behaviour change in pregnancy or engagement with smoking cessation services, were identified ( Table 33). Graham and colleagues 225 conducted a systematic review of qualitative studies to address the importance of everyday life to smoking status during pregnancy, a context that is often overlooked by research on public health issues but which is crucial for understanding how barriers and facilitators work and is therefore central to intervention design.…”

Section: Findings For Smoking Cessation In Pregnancymentioning

confidence: 99%

“…Graham and colleagues 225 conducted a systematic review of qualitative studies to address the importance of everyday life to smoking status during pregnancy, a context that is often overlooked by research on public health issues but which is crucial for understanding how barriers and facilitators work and is therefore central to intervention design. Baxter and colleagues 222 conducted a systematic review to investigate factors enabling or discouraging the uptake of smoking cessation services by pregnant smokers and they suggest 10 aspects of service delivery that may have an influence on the uptake of interventions. They identified that variation in practice can lead to conflicting advice being given to women and recommended that greater training and use of protocols is needed in this area.…”

Section: Findings For Smoking Cessation In Pregnancymentioning

confidence: 99%

“…In addition to well-established issues of identity and everyday life that serve as barriers to smoking cessation in pregnancy, all three reviews 222,225,226 found that many women also have deep-seated beliefs that the risks of smoking in pregnancy are exaggerated. Graham and colleagues 225 found that women give more weight to the experiences of friends and family than to scientific evidence or health professional advice.…”

Section: Risks and Benefitsmentioning

confidence: 99%

“…Graham and colleagues 225 found that women give more weight to the experiences of friends and family than to scientific evidence or health professional advice. Baxter and colleagues 222 identified that women perceive a lack of 'proof' that smoking is harmful to the baby. Ingall and Cropley 226 found that health professionals' advice is followed less than personal experience or the experiences of family and friends, particularly when accounts of smoking during pregnancy appear to result in a healthy baby.…”

Section: Risks and Benefitsmentioning

confidence: 99%

See 4 more Smart Citations

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Morgan

Hoddinott

Thomson

et al. 2015

Health Technology Assessment

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BackgroundSmoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby.AimTo understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design.DesignEvidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout.SettingUK.ParticipantsThe qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking.Methods(1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test.ResultsOut of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A ‘ladder’ logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical ‘ladder’ towards smoking cessation and breastfeeding. Incentive interventions provide opportunity ‘rungs’ to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women’s capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave ‘healthily’ risk them feeling pressurised and failing. To avoid ‘losing face’, women may disengage.LimitationsIncluded studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population.ConclusionsIncentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important.Study registrationThis study is registered as PROSPERO CRD42012001980.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Exclusion Criteriamentioning

confidence: 99%

Section: Findings For Smoking Cessation In Pregnancymentioning

confidence: 99%

Section: Findings For Smoking Cessation In Pregnancymentioning

confidence: 99%

Section: Risks and Benefitsmentioning

confidence: 99%

Section: Risks and Benefitsmentioning

confidence: 99%

See 3 more Smart Citations

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Morgan

Hoddinott

Thomson

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

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Supporting Pregnant Aboriginal and Torres Strait Islander Women to Quit Smoking: Views of Antenatal Care Providers and Pregnant Indigenous Women

Passey

Sanson‐Fisher

Stirling

2013

Matern Child Health J

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To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85–90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.

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Barriers and Promoters of an Evidenced-Based Smoking Cessation Counseling During Prenatal Care in Argentina and Uruguay

Colomar

Tong

Morello

et al. 2014

Matern Child Health J

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In Argentina and Uruguay, 10.3 and 18.3 %, respectively, of pregnant women smoked in 2005. Brief cessation counseling, based on the 5A’s model, has been effective in different settings. This qualitative study aims to improve the understanding of factors influencing the provision of smoking cessation counseling during pregnancy in Argentina and Uruguay. In 2010, we obtained prenatal care providers’, clinic directors’, and pregnant smokers’ opinions regarding barriers and promoters to brief smoking cessation counseling in publicly-funded prenatal care clinics in Buenos Aires, Argentina and Montevideo, Uruguay. We interviewed six prenatal clinic directors, conducted focus groups with 46 health professionals and 24 pregnant smokers. Themes emerged from three issue areas: health professionals, health system, and patients. Health professional barriers to cessation counseling included inadequate knowledge and motivation, perceived low self-efficacy, and concerns about inadequate time and large workload. They expressed interest in obtaining a counseling script. Health system barriers included low prioritization of smoking cessation and a lack of clinic protocols to implement interventions. Pregnant smokers lacked information on the risks of prenatal smoking and underestimated the difficulty of smoking cessation. Having access to written materials and receiving cessation services during clinic waiting times were mentioned as promoters for the intervention. Women also were receptive to non-physician office staff delivering intervention components. Implementing smoking cessation counseling in publicly-funded prenatal care clinics in Argentina and Uruguay may require integrating counseling into routine prenatal care and educating and training providers on best-practices approaches.

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Factors relating to the uptake of interventions for smoking cessation among pregnant women: A systematic review and qualitative synthesis

Abstract: Introduction

Cited by 50 publications

References 29 publications

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Supporting Pregnant Aboriginal and Torres Strait Islander Women to Quit Smoking: Views of Antenatal Care Providers and Pregnant Indigenous Women

Barriers and Promoters of an Evidenced-Based Smoking Cessation Counseling During Prenatal Care in Argentina and Uruguay

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