Stop smoking practitioner consensus on barriers and facilitators to smoking cessation in pregnancy and how to address these: A modified Delphi survey

Abstract

Introduction Pregnant women can experience barriers and facilitators towards achieving smoking cessation. We sought consensus from smoking cessation practitioners on how influential pre-identified barriers and facilitators can be on pregnant women's smoking behaviour, and how difficult these might be to manage. Suggestions for techniques that could help overcome the barriers or enhance the facilitators were elicited and consensus sought on the appropriateness for their use in practice. Methods Forty-four practitioners who provided cessation support to pregnant women completed a three-round modified Delphi survey. Round one sought consensus on the ‘influence’ and ‘difficulty’ of the barriers and facilitators, and gathered respondents' suggestions on ways to address these. Rounds two and three sought further consensus on the barriers and facilitators and on ‘appropriateness’ of the respondent-suggested techniques. The techniques were coded for behaviour change techniques (BCTs) content using existing taxonomies. Results Barriers and facilitators considered to be the most important mainly related to the influence of significant others and the women's motivation & self-efficacy. Having a supportive partner was considered the most influential, whereas lack of support from partner was the only barrier that reached consensus as being difficult to manage. Barriers relating to social norms were also considered influential, however these received poor coverage of respondent-suggested techniques. Those considered the easiest to address mainly related to aspects of cessation support, including misconceptions surrounding the use of nicotine replacement therapy (NRT). Barriers and facilitators relating to the women's motivation & self-efficacy, such as the want to protect the baby, were also considered as being particularly easy to address. Fifty of the 54 respondent-suggested techniques reached consensus as being appropriate. Those considered the most appropriate ranged from providing support early, giving correct information on NRT, highlighting risks and benefits and reinforcing motivating beliefs. Thirty-three BCTs were identified from the respondent-suggested techniques. ‘Social support (unspecified)’, ‘Tailor interactions appropriately’ and ‘Problem solving’ were the most frequently coded BCTs. Conclusions Involving partners in quit attempts was advocated. Existing support could be potentially improved by establishing appropriate ways to address barriers relating to pregnant smokers' ‘social norms’. In general, providing consistent and motivating support seemed favourable.

Experts’ Views on Behaviour Change Techniques for Smoking Cessation in Pregnancy: A Qualitative Study

“…The convenors welcomed the participants and informed them of what the meeting would entail. The participants were asked to read lists of barriers and facilitators (B&Fs) for smoking cessation in pregnancy and techniques that addressed these (derived from previous research [ 23 , 24 ]). These B&Fs and techniques were grouped into Theoretical Domains Framework (TDF) domains prior to the meeting [ 24 , 29 ].…”

“…These interventions can be delivered in a group or on an individual basis, either face to face or over the telephone, with a specialist advisor [ 22 ]. Recent research considered smoking cessation experts’ views on which B&Fs should be addressed as a priority, when supporting pregnant women in their quit attempts [ 23 , 24 ]. In these studies, the experts identified smoking being a norm in women’s social circles and a lack of support from partners to be the key barriers to successfully quitting whilst pregnant.…”

“…In these studies, the experts identified smoking being a norm in women’s social circles and a lack of support from partners to be the key barriers to successfully quitting whilst pregnant. Stopping smoking not being perceived as a priority by the women, a lack of motivation and low self-belief in their ability to quit were also noted as being difficult to help women to overcome [ 23 , 24 ].…”

“…However, Lorencatto and colleagues also highlighted that in practice, only a limited number of effective techniques are used by SSS [ 20 ]. Smoking cessation experts also noted that these BCTs are often inconsistently operationalised [ 23 , 24 ].…”

“…The study reported here is a part of a larger body of research into how behavioural smoking cessation support can be developed to improve quitting outcomes [ 23 , 24 ]. The aims of this study were to gain an insight into how smoking cessation experts operationalise or put to use previously identified effective BCTs in routine practice [ 23 , 24 ].…”