Lessons learned from the London Exercise and Pregnant (LEAP) Smokers randomised controlled trial process evaluation: implications for the design of physical activity for smoking cessation interventions during pregnancy

Abstract

BackgroundThe challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved.MethodsTwo focus groups, with independent facilitators, were conducted with six researchers who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis.ResultsFive themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention; (2) personal characteristics of trial participants; (3) practical issues; (4) researchers’ engagement with participants; (5) training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants’ friends and family, and post-natal return to smoking.ConclusionsFuture exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers’ friends and family, as well as for avoiding post-natal return to smoking.Trial registration ISRCTN48600346, date of registration: 21/07/2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4013-5) contains supplementary material, which is available to authorized users.

Smoking during pregnancy in the United States, 2005–2014: The role of depression

“…(Mohsin and Bauman, 2005) In fact, low-income women commonly have the lowest utilization of smoking cessation counseling services (Scheuermann et al, 2017) and interventions have been developed and evaluated to promote smoking cessation among pregnant women (Naughton et al, 2017). Most recently, smoking cessation interventions with a physical activity component targeting pregnant women have been suggested, interventions supplementing smoking cessation materials with text messaging, as well as broadening the scope of smoking screening programs to include general practitioners and obstetricians have been suggested (Giatras et al, 2017; Zeev et al, 2017; Naughton et al, 2017). Further, although smoking cessation in pregnancy has been associated with decreased depressive symptoms, implying a further benefit of large-scale smoking cessation programs, large-scale community-based trials that target depression reduction to improve smoking cessation rates among pregnant women at a population level have not been conducted (Munafo et al, 2008).…”

Influence of the social context in smoking during pregnancy

“…[...] During prenatal care, a window of opportunity for smoking cessation/reduction is opened, since there is a strong sense of guilt that causes the woman to seek to justify smoking, demonstrating that despite smoking, she is aware of the harmful effects showed that the intervention was beneficial in smoking cessation reduction/cessation. It was also considered relevant to involve family and friends as partners for more effective action (21) . Interventions for smoking cessation should go beyond biomedical and behavioral approaches, acting in community life with intersectoral actions.…”

Perspectives of health educators and interviewers in a randomized controlled trial of a postpartum diabetes prevention program for Latinas: a qualitative assessment

“…DL is a female doctoral student in Community Health Education with a Master’s degree in Public Health and more than three years of qualitative research experience in one-on-one and focus group interviewing. She moderated the sessions using a focus group discussion guide informed by prior qualitative work among research staff [14, 17] The focus group began with an introduction where DL described her background, interest in the topic, and reasons for conducting the research. Following this introduction, open-ended questions were used to understand the health educators’ and interviewers’ perspectives on implementing this lifestyle intervention.…”

“…Lifestyle interventions regularly rely on study staff to implement the intervention and collect outcomes data directly from study participants. To date, little has been done to identify the individual components of lifestyle interventions, and the aspects of their implementation, that are critical to success [14–16]. Qualitative research tools can identify staff persons’ experiences and knowledge that might otherwise remain hidden through more traditional quantitative measures [17, 18].…”

“…To our knowledge, no studies to date have collected information on the experiences of health educators and interviewers involved in implementing a lifestyle intervention to postpartum women. Prior studies implemented during pregnancy have described the perspectives of health educators and interviewers in a randomized trial of prenatal smoking cessation [14], the perspectives of interviewers in a case-control study of preterm birth [15], and the perspectives of interviewers in the Danish National Birth Cohort Study [16].…”