Abstract
Reducing smoking during pregnancy is a public health priority. Nicotine replacement therapy (NRT) is offered routinely to pregnant women who smoke in the United Kingdom. However, evidence of treatment efficacy in this population is weak, most likely due to poor adherence. Guided by the Necessity-Concerns Framework, we conducted a qualitative study to better understand pregnant women's perceived needs and concerns regarding NRT use, with consideration of combination NRT. Semi-structured interviews were conducted by telephone with 18 pregnant or recently pregnant women in England and Wales, purposively sampled for different NRT-related experiences. Participants were recruited online via Facebook adverts and through a Stop Smoking Service. A hybrid approach of deductive and inductive thematic coding was used for analysis. Findings were organized around three themes: 1) the role of motivation to stop smoking; 2) necessity beliefs about using NRT; and 3) concerns about NRT. Some women reported fluctuating motivation for stopping smoking which undermined their NRT use. Others used NRT to cut down the number of cigarettes they smoked. Reasons for low NRT necessity beliefs included a preference for quitting unassisted, low or unrealistic expectations of efficacy, and overconfidence in achieving cessation (necessity testing). Concerns included safety, particularly around increased nicotine exposure with combination NRT, addictiveness, side effects, and capability to use. Pregnant women have multiple necessity beliefs and concerns that influence their use of NRT. Targeting these, alongside increasing and maintaining motivation to quit smoking, will likely help optimize NRT use in pregnancy and improve quit rates.
Highlights
Reducing smoking during pregnancy is a public health priority
The results are presented under three main themes: 1) the role of motivation to stop smoking; 2) necessity beliefs about using Nicotine replacement therapy (NRT); and 3) concerns about NRT – and 10 subthemes
We found that the consistency and drivers of women’s motivation to stop smoking may influence their NRT use but, NRT use can potentially strengthen women’s desire to quit
Summary
Reducing smoking during pregnancy is a public health priority. Nicotine replacement therapy (NRT) is offered routinely to pregnant women who smoke in the United Kingdom. Many women quit smoking in the first few days after discovering they are pregnant (Heil et al, 2014; Solomon & Quinn, 2004), with almost half ‘spontaneously quitting’ before their first antenatal appointment (Hotham, Ali, White & Robinson, 2008) Those who continue to smoke are often more dependent on nicotine (Riaz, Lewis, Naughton, & Ussher, 2018) and so find it hard to quit. In trials enrolling pregnant smokers, those with comparable data revealed that only 7% to 29% reported finishing prescribed NRT courses (Claire et al, 2020) One explanation for this is poor treatment adherence, meaning that pregnant women do not use enough NRT, use it incorrectly, or stop treatment prematurely. Increased nicotine metabolism in pregnancy, which might make the dose of nicotine in NRT less effective at ameliorating cravings, may partly help explain this poor adherence (Bowker, Lewis, Coleman, & Cooper, 2015; Dempsey, Jacob, & Benowitz, 2002)
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