Author:
Passey Megan E.,Longman Jo M.,Adams Catherine,Johnston Jennifer J.,Simms Jessica,Rolfe Margaret
Abstract
Abstract
Background
Smoking is the most important preventable cause of adverse pregnancy outcomes, but provision of smoking cessation support (SCS) to pregnant women is poor. We examined the association between midwives’ implementation of SCS (5As – Ask, Advise, Assess, Assist, Arrange follow-up) and reported barriers/enablers to implementation.
Methods
On-line anonymous survey of midwives providing antenatal care in New South Wales (NSW), Australia, assessing provision of the 5As and barriers/enablers to their implementation, using the Theoretical Domains Framework (TDF). Factor analyses identified constructs underlying the 5As; and barriers/enablers. Multivariate general linear models examined relationships between the barrier/enabler factors and the 5As factors.
Results
Of 750 midwives invited, 150 (20%) participated. Respondents more commonly reported Asking and Assessing than Advising, Assisting, or Arranging follow-up (e.g. 77% always Ask smoking status; 17% always Arrange follow-up). Three 5As factors were identified– ‘Helping’, ‘Assessing quitting’ and ‘Assessing dependence’. Responses to barrier/enabler items showed greater knowledge, skills, intentions, and confidence with Assessment than Assisting; endorsement for SCS as a priority and part of midwives’ professional role; and gaps in training and organisational support for SCS. Nine barrier/enabler factors were identified. Of these, the factors of ‘Capability’ (knowledge, skills, confidence); ‘Work Environment’ (service has resources, capacity, champions and values SCS) and ‘Personal priority’ (part of role and a priority) predicted ‘Helping’.
Conclusion
The TDF enabled systematic identification of barriers to providing SCS, and the multivariate models identified key contributors to poor implementation. Combined with qualitative data, these results have been mapped to intervention components to develop a comprehensive intervention to improve SCS.
Funder
National Health and Medical Research Council of Australia
Cancer Institute NSW
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynaecology
Reference39 articles.
1. British Medical Association. Smoking and reproductive life: the impact of smoking on sexual, reproductive and child health. London: British Medical Association; 2004.
2. Chamberlain C, O'Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2017(2):Art. No.: CD001055. https://doi.org/10.1002/14651858.CD001055.pub5.
3. Bakker H, Jaddoe VWV. Cardiovascular and metabolic influences of fetal smoke exposure. Eur J Epidemiol. 2011;26(10):763–70.
4. U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general. Rockville: US Department of Health and Human Services; 2006.
5. Flemming K, McCaughan D, Angus K, Graham H. Qualitative systematic review: barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth. J Adv Nurs. 2015;71(6):1210–26.