Abstract
BackgroundSmoking during pregnancy increases the risk of multiple serious adverse infant, child and maternal outcomes, yet nearly 10% of Australian women still smoke during pregnancy. Despite evidence-based guidelines that recommend routine and repeated smoking cessation support (SCS) for all pregnant women, the provision of recommended SCS remains poor. Guidance on developing complex interventions to improve health care recommends drawing on existing theories, reviewing evidence, undertaking primary data collection, attending to future real-world implementation, and designing and refining interventions using iterative cycles with stakeholder input throughout. Here we describe using the Behaviour Change Wheel (BCW) to apply these principles in developing an intervention to improve provision of SCS in Australian maternity services.MethodsWorking closely with key stakeholders in the New South Wales (NSW) health system, we applied the steps of the BCW method then undertook a small feasibility study in one service to further refine the intervention. Stakeholders were engaged in multiple ways – as a core research team member, through a project Advisory Group, targeted meetings with policy makers, a large workshop to review potential components and the feasibility study. ResultsBarriers to and enablers of providing SCS were identified in five of six components described in the BCW method (psychological capability, physical opportunity, social opportunity, and in reflective and automatic motivation). These were mapped to intervention types and we selected education, training, enablement, environmental restructuring, persuasion, incentivisation and modelling as suitable in our context. Through application of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects, and Equity) in the stakeholder workshop, behaviour change techniques were selected and applied in developing the intervention which includes systems, clinician and leadership elements. The feasibility study confirmed feasibility and acceptability of the midwifery component and the need to further strengthen the leadership component. ConclusionsUsing the BCW method combined with strong stakeholder engagement from inception resulted in transparent development of the MOHMQuit intervention, which targets identified barriers to and enablers of the provision of SCS and is developed specifically for the context in which it will be implemented. The intervention is being trialed in eight public maternity services in NSW.
Views of Ontarians About Health Professionals’ Smoking Cessation Advice
