Factors influencing midwives’ conversations about smoking and referral to specialist support: a qualitative study informed by the Theoretical Domains Framework

Author:

Knowles Nicky12ORCID,Elliott Megan3ORCID,Cline Alice4,Poole Helen5

Affiliation:

1. Public Health Wales Behavioural Science Unit, No. 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK

2. School of Psychology, Liverpool John Moores University

3. Cwm Taf Morgannwg University Health Board, UK

4. Public Health Wales Behavioural Science Unit, UK

5. School of Psychology, Liverpool John Moores University, UK

Abstract

Aims: The aim of this study was to identify factors influencing midwives’ conversations about smoking, and referral to specialist smoking cessation services, using an evidence-based theoretical framework. Methods: Semi-structured, qualitative interviews were undertaken with community midwives employed within one health board region of Wales. Deductive framework analysis was employed by coding data to the domains of the Theoretical Domains Framework (TDF) and then identifying themes within domains and across participants. Results: Seven midwives took part in the study. 13, out of a possible 14 domains, were mapped from the TDF. Key enablers to conversations and referrals include knowledge of the risks of smoking in pregnancy, congruence with the professional identity of a midwife, and the use of carbon monoxide monitors in initiating conversations and referrals. Limited knowledge of the specialist service, confusion about the opt-out pathway, varied skills in communicating and engaging with women, low confidence in ability to influence women’s decisions, limited appointment times, and competing priorities were identified as barriers. Conclusion: Midwives recognise the importance of their role within the provision of smoking cessation advice and referral to specialist services. While there are continued time pressures and competing priorities for midwives, enhancing skills and confidence in collaborative, empowering approaches to addressing smoking would further support in optimising the uptake of maternity smoking cessation support. This could also enhance conversations about other public health issues such diet, physical activity, and alcohol use.

Publisher

SAGE Publications

Reference26 articles.

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2. Welsh government. Maternity and birth statistics, 2021. Available online at: https://www.gov.wales/maternity-and-birth-statistics-2021-html#section-98764 (2021, accessed April 2023).

3. National Health Service England. NHS helps thousands of pregnant smokers kick the habit. Available online at: https://www.england.nhs.uk/2022/07/nhs-helps-thousands-of-pregnant-smokers-kick-the-habit/ (2022, accessed April 2023).

4. Royal College of Paediatrics Child Health. Smoking during pregnancy. Available online at: https://stateofchildhealth.rcpch.ac.uk/evidence/maternal-perinatal-health/smoking-pregnancy/#:~:text=England%3A%20Though%20there%20has%20been%20a%20steady%20decline,smoking%20at%20the%20time%20of%20delivery%20in%202017%2F18.6 (2020, accessed April 2023).

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