Midwives' Knowledge, Perceptions, Beliefs, and Practice Supports Regarding Tobacco Dependence Treatment

Abstract

Clinical practice guidelines and evidence-based reviews confirm the efficacy of tobacco dependence treatment for pregnant women. The purpose of this study was to examine tobacco dependence treatment practices among certified nurse-midwives who treat pregnant women who smoke. Midwives were surveyed to determine knowledge, perceptions, and beliefs about tobacco cessation treatment and to identify practice environmental factors that support treatment practices. Half of all midwives had not heard of the US Public Health Service Guidelines (5 A's) to assist smokers in cessation treatment. We found varying levels of adherence to the clinical practice guidelines. Nearly all midwives routinely ask, advise, and assess; while fewer encourage patients to set a quit date or discuss medication options (assist) and perform follow-up activities (arrange). Barriers significantly associated with clinical tobacco treatment practice are lack of training and competing priorities in the visit. One-office support, a system in place to provide smoking cessation information and resources, was associated with increased practice. In summary, midwives believe they should be providing tobacco dependence treatment, yet they identify a need for training. The findings of this study also indicate that sustained practice change, which includes the entire practice environment, should be targeted to enhance tobacco dependence treatment.

Opportunities to Improve the Role of Family Practice Nurses in Increasing the Uptake of Evidence-Based Smoking Cessation Interventions for Pregnant Women: An Exploratory Survey

“…Respondents identified that for half or more of the pregnant women they see, during routine prenatal care visits, 56% "Assist" with the quitting process and 52% "Arrange" follow-up support. This finding is consistent with other studies exploring health care providers' counselling practices for pregnant smokers in Canada and the United States [18,26,27]. Despite having evidence-based best practice guidelines for smoking cessation for more than a decade, the rate of guideline implementation is sub-optimal.…”

Barriers and facilitators to smoking cessation in pregnancy and in the post‐partum period: The health care professionals’ perspective

“…Conventionally, such deficits are addressed by training. But unlike many aspects of clinical care, smoking in pregnancy training opportunities appeared to be limited and non‐mandatory for our participants, as reported elsewhere (Abatemarco et al ., 2007; Flemming et al ., 2016). Non‐mandatory training may influence professional beliefs about the relative importance of smoking in pregnancy compared to other risk factors for which training is mandatory.…”

“…For example, a recent focus on tackling obesity in pregnancy appeared to reduce the perceived priority of smoking among antenatal professionals. Low prioritization of smoking cessation has been identified previously as a barrier (Abatemarco et al ., 2007; Colomar et al ., 2015), and our findings provide new insight into how priorities may be affected inadvertently by new initiatives targeting other health behaviours. Many parallels with smoking in pregnancy can be drawn with midwives’ experience of discussing obesity with pregnant women and referring them to weight management services (Atkinson, French, Ménage, & Olander, 2017).…”

“…This includes not raising the topic when a negative reception is anticipated and variable rates of referral due to the offer of choice (opt‐in) or not (opt‐out). Addressing either smoking or obesity is likely to be compounded by the perceived lack of time among health care professionals, particularly midwives, to address lifestyle behaviour change (Abatemarco et al ., 2007; Herberts & Sykes, 2012) and a prioritization for discussing the clients’ concerns, usually about labour (Flemming et al ., 2016), during consultations.…”

“…Surveys indicate, however, that only around one‐third of professionals across these groups routinely discuss support or treatment options for cessation and less than one quarter follow up women to ask about their smoking after an initial discussion (Abatemarco, Steinberg, & Delnevo, 2007; Jordan et al ., 2006; Price, Jordan, & Dake, 2006b). Although midwives are reported to be more likely to provide risk information than other pregnancy‐orientated health care professionals (Abatemarco et al ., 2007; Chang et al ., 2013), they are much less likely to recommend that women abstain from smoking completely (Glover et al ., 2008). This matches the experience reported by pregnant smokers (Owen & Penn, 1999; Ussher, Etter, & West, 2006).…”