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

Abstract

Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.

Knowledge, Attitudes, and Beliefs about Relapse Prevention Research Involving Bupropion among Current and Former Pregnant Individuals Who Smoke

“…This attitude was particularly true for women who planned to breastfeed. Prior literature is consistent with these findings, showing that postpartum individuals are unlikely to use pharmacological treatments for tobacco dependence [31,42,43]. The Health Belief Model may partially explain this.…”

“…Thus, healthcare providers appear to be a trusted information source for communicating risk of relapse as well as the risks and benefits of pharmacological and behavioral interventions. Similar research has also shown healthcare clinicians as trusted resources for relapse prevention [41,42]. Educating pregnant individuals on their high risk of relapse may increase interest in postpartum relapse prevention treatments.…”

Smoking Cessation Support for Pregnant Women Provided by English Stop Smoking Services and National Health Service Trusts: A Survey

“…The NCSCT also provide practitioners' skills-based training modules in delivering stop smoking support. The similarity between LA and NHS Trusts' support methods and the utilisation of the same skills-based training packages illustrate the value of having a national centre to set standards of training and define treatments, all of which promote better clinical practice and better cessation outcomes for smokers [25] as well ensure the consistent factual messaging from health care professionals, valued by pregnant women [26].…”

Practitioners’ Views on Nicotine Replacement Therapy in Pregnancy during Lapse and for Harm Reduction: A Qualitative Study

“…It was felt that suggesting to women, who may be finding it difficult to quit, that they may be better trying a harm reduction approach would undermine practitioners’ current training and personal beliefs. It may also contribute to pregnant women’s confusion around NRT at a time when clear and consistent messages from health care professionals is needed [50] and increase the likelihood of women choosing and acting on information that allows them to continue to smoke when they may otherwise have successfully quit.…”