Abstract
BackgroundGeneral practitioners can play an important role in addressing smoking among pregnant women but studies suggest they rarely do so. The aim of this study was to explore general practitioners perceptions about the management of smoking in pregnancy, and what would enable them to provide better care.MethodsQualitative semi-structured interviews were conducted (Feb-July 2017), with 19 Australian general practitioners recruited from a sample that participated in a national survey on managing smoking during pregnancy; and through a national conference. The interview guide was structured using the theoretical domains framework, exploring previously reported barriers and two specific components of smoking cessation care - nicotine replacement therapy prescription and Quitline referral.ResultsParticipants reported high confidence and knowledge to provide pregnant patients adequate support for quitting. Nonetheless, participants reported lacking communication skills, focusing on providing information on smoking harm, accepting cutting down cigarettes as adequate, while following the ‘Stages of Change’ model and only providing treatment options to motivated patients. Lack of time, nicotine replacement therapy cost and safety concerns, and being unfamiliar with the Quitline (particularly for Aboriginal and Torres Strait Islander pregnant smokers) were perceived as challenges. Participants reported needing better communication skills, clear detailed nicotine replacement therapy guidelines for special populations, and visual resources they could use to discuss treatment options with patients.ConclusionsDifficulty communicating with pregnant patients about smoking, using the ‘Stages of Change’ model to guide support provision and concerns regarding nicotine replacement therapy safety are barriers to providing cessation support to pregnant patients for general practitioners. Training on specific effective behaviour change techniques, clear guidance for nicotine replacement therapy use, and practical visual patient education tools may facilitate smoking cessation care provision to pregnant women.
Highlights
General practitioners can play an important role in addressing smoking among pregnant women but studies suggest they rarely do so
We included in the study all of the general practitioners (GPs) who responded to our invitation, resulting in 16 GPs recruited through the survey database and 3 GPs recruited through the conference
This study reveals that all of the 19 participating GPs use the ‘stages of change’ model to guide their intervention with pregnant women
Summary
General practitioners can play an important role in addressing smoking among pregnant women but studies suggest they rarely do so. The aim of this study was to explore general practitioners perceptions about the management of smoking in pregnancy, and what would enable them to provide better care. Rates of smoking among pregnant women range from 7 to 18% [1]. Recognised clinical guidelines recommend using the 5A’s approach when treating pregnant women who smoke [5]. The Royal Australian Collage of General Practitioners (RACGP) recommend using the 5A’s [6] and structure the recommended counselling approach using the Trans-Theoretical theory, i.e. the. ‘stages of change’ model [7] According to this theory, smokers transition though a cycle of readiness to change their behaviour [7]. Evidence suggests that this approach is outdated, and interventions based on stages of change have not been shown to be more effective than non-stage-based interventions [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
