Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals.

Ross Thomson,Jane Dyas,Joanne Emery,Lisa Mcdaid,Tim Coleman,Sue Cooper,Felix Naughton

doi:10.3390/ijerph16101814

Abstract

Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.

Highlights

Smoking during pregnancy is a leading cause of adverse prenatal outcomes, including miscarriage [1], stillbirth [2], and prematurity [3]
We extracted two main themes concerning how knowledge and education can act as barriers and facilitators to nicotine replacement therapy (NRT) use in pregnancy
We explore, from a stop smoking professional’s perspective, how some pregnant women assimilate knowledge about NRT from others and the way this can have a detrimental effect on initiation and sustained NRT use while attempting to stop smoking

Summary

Introduction

Smoking during pregnancy is a leading cause of adverse prenatal outcomes, including miscarriage [1], stillbirth [2], and prematurity [3]. It is associated with a wide range of childhood health problems [4]. Most pregnant smokers are motivated to quit [7] and specialist Stop Smoking Services (SSSs) in England offer these women free cessation support, up to 75% of women who are referred to SSSs do not take up these appointments [8,9]. While NRT is a well-established, effective cessation treatment in non-pregnant

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