A behaviour change intervention to reduce home exposure to second hand smoke during pregnancy in India and Bangladesh: a theory and evidence-based approach to development

Veena A Satyanarayana,Mukesh Dherani,Shammi Nasreen,Kamran Siddiqi,Pratima Murthy,Rumana Huque,Prabha S Chandra,Cath Jackson,Atif Rahman

doi:10.1186/s40814-021-00811-5

Abstract

BackgroundHome exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in low- and middle-income countries like India and Bangladesh. The literature on the efficacy of behaviour change interventions to reduce home exposure to SHS in pregnancy is scarce.MethodsWe employed a theory and evidence-based approach to develop an intervention using pregnant women as agents of change for their husband’s smoking behaviours at home. A systematic review of SHS behaviour change interventions led us to focus on developing a multicomponent intervention and informed selection of behaviour change techniques (BCTs) for review in a modified Delphi survey. The modified Delphi survey provided expert consensus on the most effective BCTs in reducing home exposure to SHS. Finally, a qualitative interview study provided context and detailed understanding of knowledge, attitudes and practices around SHS. This insight informed the content and delivery of the proposed intervention components.ResultsThe final intervention consisted of four components: a report on saliva cotinine levels of the pregnant woman, a picture booklet containing information about SHS and its impact on health as well strategies to negotiate a smoke-free home, a letter from the future baby to their father encouraging him to provide a smoke-free home, and automated voice reminder and motivational messages delivered to husbands on their mobile phone. Intervention delivery was in a single face-to-face session with a research assistant who explained the cotinine report, discussed key strategies for ensuring a smoke-free environment at home and practised with pregnant women how they would share the booklet and letter with their husband and supportive family members.ConclusionA theory and evidence-based approach informed the development of a multicomponent behaviour change intervention, described here. The acceptability and feasibility of the intervention which was subsequently tested in a pilot RCT in India and Bangladesh will be published later.

Highlights

Home exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in lowand middle-income countries like India and Bangladesh
In low- and middleincome (LAMI) countries, most SHS exposure amongst women in the reproductive age group occurs at home, where women spend most of their time [4, 5]
The seven behaviour change techniques (BCTs) that were most preferred by experts in round 3 were used to guide the development of the IMPRESS intervention

Summary

Introduction

Home exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in lowand middle-income countries like India and Bangladesh. A more recent study [7] using the Demographic and Health Survey data (2008 and 2013) from 30 LAMI countries (N = 37,427 pregnant women) found that the weighted countryspecific prevalence of SHS exposure ranged from 7% (6– 9%) in Nigeria to 81% (72–88%) in Armenia. Pregnant women in the Southeast Asian countries had the highest probability of exposure Those in urban areas had a higher probability for household SHS exposure than pregnant women in rural areas. Exposure to SHS during pregnancy is associated with a range of adverse maternal and infant health outcomes such as pregnancy complications, low birth weight, still birth, small for gestational age infants and sudden infant death syndrome [8,9,10,11,12,13]

Methods

Results

Discussion

Conclusion