Factors relating to the uptake of interventions for smoking cessation among pregnant women: a systematic review and qualitative synthesis.
ABSTRACT The review had the aim of investigating factors enabling or discouraging the uptake of smoking cessation services by pregnant women smokers.
The literature was searched for papers relating to the delivery of services to pregnant or recently pregnant women who smoke. No restrictions were placed on study design. A qualitative synthesis strategy was adopted to analyze the included papers.
Analysis and synthesis of the 23 included papers suggested 10 aspects of service delivery that may have an influence on the uptake of interventions. These were whether or not the subject of smoking is broached by a health professional, the content of advice and information provided, the manner of communication, having service protocols, follow-up discussion, staff confidence in their skills, the impact of time and resource constraints, staff perceptions of ineffectiveness, differences between professionals, and obstacles to accessing interventions.
The findings suggest variation in practice between services and different professional groups, in particular regarding the recommendation of quitting smoking versus cutting down but also in regard to procedural aspects, such as recording status and repeat advice giving. These differences offer the potential for a pregnant woman to receive contradicting advice. The review suggests a need for greater training in this area and the greater use of protocols, with evidence of a perception of ineffectiveness/pessimism toward intervention among some service providers.
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ABSTRACT: ABSTRACT: Objective: To investigate midwives' experiences of using carbon monoxide (CO) monitoring for smoking cessation in pregnancy as part of routine antenatal care for pregnant women. Design: A qualitative design based on descriptive phenomenology was used. Purposive and snowball sampling was used to recruit midwives that use or have used the carbon monoxide breath test in the UK. Ten semi-structured interviews were conducted. Participants: The ten midwives interviewed had used the CO breath test in different ways. Their work experience ranged from one to over 20 years. Findings: Time constraints, lack of training, and unclear referral pathways were found to be significant barriers to the implementation of CO monitoring as routine practice. Overall participants were positive about it and found it was easy to use. Being sensitive and non-judgmental was considered essential to avoid women feeling guilty about smoking and being supportive of quit attempts. Key conclusions: This study suggests that despite initial concerns the test seems to be generally accepted by midwives. The importance of having a clear referral pathway and support network with links to a smoking cessation specialist midwife was highlighted in this study. Implications for practice: Time constraints at the booking appointment were an identified barrier. Involvement of auxiliary staff to support the midwife in offering the CO breath test could help to overcome this. Further research is needed to determine effective referral pathways to support more women to stop smoking during pregnancy. (27 references) (Author)
- International Journal of Gynecology & Obstetrics 10/2012; 119:S165. DOI:10.1016/S0020-7292(12)60046-0 · 1.56 Impact Factor
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ABSTRACT: Nicotine dependence is characteristically a chronic and relapsing disease. Although 75%-85% of smokers would like to quit, and one-third make at least three serious lifetime attempts, less than 50% of smokers succeed in stopping before the age of 60. Relevant and complex factors contributing to sustained cigarette consumption, and strongly implicated in the clinical management of smokers, are the level of nicotine dependence and psychological distress. In this review of the literature, these two factors will be examined in detail to show how they may affect smoking cessation outcome and to encourage clinicians to assess patients so they can offer tailored support in quitting smoking.Psychology Research and Behavior Management 09/2011; 4:119-28. DOI:10.2147/PRBM.S14243