Focus groups with pregnant smokers: barriers to cessation, attitudes to nicotine patch use and perceptions of cessation counselling by care providers

Abstract

Focus group methodology was used to determine the barriers to smoking cessation for pregnant women prior to the commencement of a randomised controlled smoking cessation trial (RCT), using nicotine patches in the treatment arm. Attitudes to the use of nicotine patches and perceptions of care provider counselling were also explored. Women were identified by researcher interview in the antenatal clinics as current smokers or recent 'quitters' and recruited to one of three focus groups. A number of barriers to achieving smoking cessation were identified. Pregnancy-specific barriers included scepticism about smoking-related harms. Other barriers, such as addiction to nicotine and the smoking behaviour of others, particularly partners, are generic. The latter is magnified in pregnancy by the heightened complexities of familial relationships. Potential use of patches was acceptable to most women, although some high-risk patients expressed doubts about safety and believed continued smoking was preferable. Women recounted that care providers differed in approaches to smoking cessation. Reporting 'cutting down' generally avoided further inquiries about smoking. The knowledge gained of pregnant women's perspectives enhanced the researchers' understanding in these areas. These insights have been incorporated into staff training initiatives, have guided the planning of the RCT, and have continued to inform its conduct.

Exploring the barriers of quitting smoking during pregnancy: A systematic review of qualitative studies

“…2,14 one in Sweden, 1 one in Canada 15 and one in Australia. 16 Six of the studies employed interviews as a data collection method 1,2,12-15 and one study used focus groups. 16 One study conducted two interviews with the same women.…”

“…16 Six of the studies employed interviews as a data collection method 1,2,12-15 and one study used focus groups. 16 One study conducted two interviews with the same women. 15 Two studies carried out three interviews with the same women 2,14 and the four remaining studies did not specify how many times women participated.…”

“…14,16 The total number of participants in the seven studies was 183, with a range of 11 women to 53 women participating. The studies reviewed all used opportunity samples.…”

“…13 A further study that demonstrated how women make sense of their smoking during pregnancy, concluded that women feel ashamed of their smoking and try to justify their smoking behaviour. 1,16 However, despite these negative emotions, smoking was still depicted as an essential daily coping mechanism. Furthermore, women lacked self confidence regarding their ability to maintain abstinence postnatally, which consequently decreased their motivation to attempt to quit during pregnancy.…”

“…Furthermore, women lacked self confidence regarding their ability to maintain abstinence postnatally, which consequently decreased their motivation to attempt to quit during pregnancy. 12,16 Haslam and Draper 12 explored 'awareness' to the related health risks of smoking during pregnancy. The study illustrated that despite women having medical knowledge and being aware of health risks, there was still an inclination to trust personal experience and experiences of others over medical advice.…”