Abstract
BackgroundSmoking 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.MethodsOn-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.ResultsOf 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’.ConclusionThe 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.
Highlights
Smoking is the most important preventable cause of adverse pregnancy outcomes, but provision of smoking cessation support (SCS) to pregnant women is poor
In New South Wales (NSW), only 46% of women who smoked in pregnancy recalled being told about quitting programs [11]
The objective of this paper is to examine the association between midwives’ self-reported implementation of the 5As and reported barriers and enablers to their implementation, in order to identify critical areas for interventions designed to increase provision of SCS
Summary
Smoking is the most important preventable cause of adverse pregnancy outcomes, but provision of smoking cessation support (SCS) to pregnant women is poor. Smoking is the single most important preventable cause of adverse infant outcomes including stillbirth, preterm birth, low birth weight, asthma, childhood respiratory infections and adult cardiovascular disease [1,2,3,4] These harms are significantly reduced if women stop smoking during pregnancy [2]. In Australia, clinical guidelines recommend routine and repeated assessment of smoking status for all pregnant women with ongoing support for quitting and staying quit, using the evidence-based 5As framework (Ask, Advise, Assess, Assist and Arrange follow-up) [6]. This means that, at every antenatal visit, the woman should be Asked her smoking status. The failure to deliver smoking cessation support (SCS) is a critical missed opportunity to support cessation
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