Factors relating to the uptake of interventions for smoking cessation among pregnant women: A systematic review and qualitative synthesis
Section of Public Health, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. Nicotine & Tobacco Research
(Impact Factor: 3.3).
07/2010; 12(7):685-94. DOI: 10.1093/ntr/ntq072
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.
Available from: Maeve O'Connell
- "The detrimental effects of smoking in pregnancy for mother and child have been widely documented. Smoking is linked to an increased risk of pregnancy and neonatal complications such as abruption, placenta praevia, premature labour, perinatal mortality, intrauterine growth restriction, neonatal stress and irritability, hearing loss, and respiratory problems (Dunkley 2000, King & Edwards 2009, Lumley et al 2009, Baxter et al 2010, Godfrey et al 2010). It also affects fertility — both male and female. "
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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)
Available from: Noomi Carlsson
- "As in Irwin et al. , the parents in our study might have given the impression of having good knowledge and the CHC nurse may not have wanted to destroy that image by checking what they actually knew. The parents in our study reported a high level of respect and empathy from the CHC nurse, and nurses might have been afraid of damaging their relationship with the parents, as described by Baxter et al. . "
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ABSTRACT: Child health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents' experiences from participating in a nursebased tobacco prevention intervention.
Eleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process.
The analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents' smoking.
The clinical implication is that CHC is an important arena for preventive work aiming to minimize children's tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.
Available from: José M Belizán
- "A recently published systematic review of 23 studies identified 10 aspects of service delivery relating to the uptake of interventions for smoking cessation among pregnant women. 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 . "
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ABSTRACT: Argentina and Uruguay are among the countries with the highest proportion of pregnant women who smoke. The implementation of an effective smoking cessation intervention would have a significant impact on the health of mothers and infants. The "5 A's" (Ask, Advise, Assess, Assist, Arrange) is a strategy consisting of a brief cessation counseling session of 5--15 minutes delivered by a trained provider. The "5 A's" is considered the standard of care worldwide; however, it is under used in Argentina and Uruguay.
We will conduct a two-arm, parallel cluster randomized controlled trial of an implementation intervention in 20 prenatal care settings in Argentina and Uruguay. Prenatal care settings will be randomly allocated to either an intervention or a control group after a baseline data collection period. Midwives' facilitators in the 10 intervention prenatal clinics (clusters) will be identified and trained to deliver the "5 A's" to pregnant women and will then disseminate and implement the program. The 10 clusters in the control group will continue with their standard in-service activities. The intervention will be tailored by formative research to be readily applicable to local prenatal care services at maternity hospitals and acceptable to local pregnant women and health providers. Our primary hypothesis is that the intervention is feasible in prenatal clinics in Argentina and Uruguay and will increase the frequency of women receiving tobacco use cessation counseling during pregnancy in the intervention clinics compared to the control clinics. Our secondary hypotheses are that the intervention will decrease the frequency of women who smoke by the end of pregnancy, and that the intervention will increase the attitudes and readiness of midwives towards providing counseling to women in the intervention clinics compared to the control clinics.Trial registration: ClinicalTrials.gov. Identifier: NCT01852617.
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