Improving Behavioral Support for Smoking Cessation in Pregnancy: What Are the Barriers to Stopping and Which Behavior Change Techniques Can Influence These? Application of Theoretical Domains Framework.

Katarzyna A Campbell,Tom Coleman-Haynes,Jane Dyas,Tim Coleman,Michael Ussher,Fabiana Lorencatto,Libby Fergie,Sue Cooper

doi:10.3390/ijerph15020359

Abstract

Behavioral support interventions are used to help pregnant smokers stop; however, of those tested, few are proven effective. Systematic research developing effective pregnancy-specific behavior change techniques (BCTs) is ongoing. This paper reports contributory work identifying potentially-effective BCTs relative to known important barriers and facilitators (B&Fs) to smoking cessation in pregnancy; to detect priority areas for BCTs development. A Nominal Group Technique with cessation experts (n = 12) elicited an expert consensus on B&Fs most influencing women’s smoking cessation and those most modifiable through behavioral support. Effective cessation interventions in randomized trials from a recent Cochrane review were coded into component BCTs using existing taxonomies. B&Fs were categorized using Theoretical Domains Framework (TDF) domains. Matrices, mapping BCT taxonomies against TDF domains, were consulted to investigate the extent to which BCTs in existing interventions target key B&Fs. Experts ranked ‘smoking a social norm’ and ‘quitting not a priority’ as most important barriers and ‘desire to protect baby’ an important facilitator to quitting. From 14 trials, 23 potentially-effective BCTs were identified (e.g., ‘information about consequences). Most B&Fs fell into ‘Social Influences’, ‘Knowledge’, ‘Emotions’ and ‘Intentions’ TDF domains; few potentially-effective BCTs mapped onto every TDF domain. B&Fs identified by experts as important to cessation, are not sufficiently targeted by BCT’s currently within interventions for smoking cessation in pregnancy.

Highlights

Smoking in pregnancy is detrimental to both mothers’ and babies’ health [1,2,3]
We aimed to derive an expert consensus on the barriers and facilitators (B&Fs) that most influence women’s smoking cessation and are most modifiable through behavioral support; to describe any behavior change techniques (BCTs) used in recent behavioral cessation interventions for pregnant women with randomized controlled trial-evidence of effectiveness [18]; and, in the context of the Theoretical Domains Framework (TDF) [20], to match all these potentially-effective BCTs to B&Fs
Using methodology described by Michie et al [19] and replicated by Lorencatto et al [18] we identified BCTs used in smoking cessation interventions in pregnancy for which there was randomized control trial-level (RCT) evidence of effectiveness

Summary

Introduction

Smoking in pregnancy is detrimental to both mothers’ and babies’ health [1,2,3] It is a significant public health concern in developed countries—for example, around 10% of pregnant women are reported to smoke in the UK [4] and Canada [5], and 8.4% in the U.S [6]. Younger women, those in routine or manual occupations and those who never worked, as well as women who live with at least. Public Health 2018, 15, 359; doi:10.3390/ijerph15020359 www.mdpi.com/journal/ijerph

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