Publisher: BioMed Central
Journal: BMC Public Health
Subjects: Process evaluation, Pregnant smokers, Research Article, RA1-1270, Smoking cessation, Public aspects of medicine, Qualitative, Exercise, Physical activity intervention, Researchers’ perspective, Public Health, Environmental and Occupational Health
Background The challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved. Methods Two focus groups, with independent facilitators, were conducted with six researchers who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis. Results Five themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention; (2) personal characteristics of trial participants; (3) practical issues; (4) researchers’ engagement with participants; (5) training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants’ friends and family, and post-natal return to smoking. Conclusions Future exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers’ friends and family, as well as for avoiding post-natal return to smoking. Trial registration ISRCTN48600346, date of registration: 21/07/2008. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4013-5) contains supplementary material, which is available to authorized users.
The results below are discovered through our pilot algorithms. Let us know how we are doing!
- 1. Chamberlain C, O'Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2013;(10):CD001055.
- 2. Olstad DL, Ball K, Abbott G, McNaughton SA, Le HND, Mhurchu CN, Pollard C, Crawford DA. A process evaluation of the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial. Int J Behav Nutr Phys Act. 2016;13:27. doi:10.1186/s12966-016-0352-3.
- 3. Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to-guide. Health Promot Pract. 2005;6(2):134-47.
- 4. Walsh RA, Redman S, Byrne JM, Melmeth A, Brinsmead MW. Process measures in an antenatal smoking cessation trial: another part of the picture. Health Educ Res. 2000;15(4):469-83.
- 5. Windsor R, Clark J, Cleary S, Davis A, Thorn S, Abroms L, Wedeles J. Effectiveness of the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) dissemination project: a science to prenatal care practice partnership. Matern Child Health J. 2014;18(1):180-90.
- 6. Lowe JB, Balanda KP, Clare G. Evaluation of antenatal smoking cessation programs for pregnant women. Aust N Z J Public Health. 1998;22(1):55-9.
- 7. Ussher M, Aveyard P, Manyonda I, Lewis S, West R, Lewis B, et al. Physical activity as an aid to smoking cessation during pregnancy (LEAP) trial: study protocol for a randomized controlled trial. Trials. 2012;13:186.
- 8. Ussher M, Lewis S, Aveyard P, Manyonda I, West R, Lewis B, Marcus B, Riaz M, Taylor A, Daley A, Coleman T. Physical activity for smoking cessation in pregnancy: randomised controlled trial. BMJ. 2015;14:350. h2145.
- 9. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O'Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;19:350. h1258.
- 10. Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description - the poor cousin of health research? BMC Med Res Methodol. 2009;16(9):52.
- 11. Kitzinger J. Qualitative research: introducing focus groups. BMJ. 1995;3(11):299.
- 12. NHS Centre for Smoking Cessation and Training: NCSCT. Training standard: learning outcomes for training stop smoking practitioners. London: NHS; 2010.
- 13. Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed. London: Sage; 1998.
- 14. Mays N, Pope C. Quality in qualitative health research. In: Pope C, Mays N, editors. Qualitative Research in Health Care. Oxford: Blackwell Publishing Ltd.; 2006. p. 82-101.
- 15. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psych. 2006;3(2):77-101.
- 16. Denzin K. The Research Act. New York: McGraw-Hill; 1978.
- 17. Clark JP. How to peer review a qualitative manuscript. In: Godlee F, Jefferson T, editors. Peer Review in Health Sciences. 2nd ed. London: BMJ Books; 2003. p. 219-35.
- 18. Graham H, Francis B, Inskip HM, Harman J, SWS Study Group. Socioeconomic lifecourse influences on women's smoking status in early adulthood. J Epidemiol Community Health. 2006;60:228-33.
- 19. Ussher MH, Taylor AH, Faulkner GE Exercise interventions for smoking cessation. Cochrane Database Syst Rev. 2014;(8):CD002295.
- 20. Emmons KM, Marcus BH, Linnan L, Rossi JS, Abrams DB. Mechanisms in multiple risk factor interventions: Smoking, exercise, and dietary fat intake among manufacturing workers. Prev Med. 1994;23(4):481-9.
- 21. King TK, Marcus BH, Pinto BM, Emmon, KM, Abrams DB. Cognitive behavioural mediators of changing multiple behaviours: Smoking and a sedentary lifestyle. Prev Med. 1996;25(6):684-91.
- 22. McEwen A, Hajek P, McRobbie H, West R. Manual of smoking cessation: a guide for counsellors and practitioners. Oxford: Blackwell Publishing; 2006.
- 23. Everson-Hock ES, Taylor AH, Ussher M, Faulkner G. A qualitative perspective on multiple health behaviour change: views of smoking cessation advisors who promote physical activity. J Smok Cessat. 2010;5:7-14.
- 24. Hyman DJ, Pavlik VN, Taylor WC, Goodrick GK, Moye L. Simultaneous vs sequential counseling for multiple behaviour change. Arch Intern Med. 2007;167:1152-8.
- 25. Marcus BH, Albrecht AE, Niaura RS, Taylor ER, Simkin LR, Feder SI, et al. Exercise enhances the maintenance of smoking cessation in women. Addict Behav. 1995;20:87-92.
- 26. Taylor AH, Ussher MH, Faulkner G. The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect and smoking behaviour: A systematic review. Addiction. 2007;102:534-43.
- 27. Gavin NI, Gaynes BN, Lohr KN, et al. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106:1071-83.
- 28. Blalock JA, Fouladi RT, Wetter DW, Cinciripini PM. Depression in pregnant women seeking smoking cessation treatment. Addict Behaviors. 2005;30(6): 1195-208.
- 29. Howard LM, Bekele D, Rowe M, Demilew J, Bewley S, Marteah TM. Smoking cessation in pregnant women with mental disorders: a cohort and nested qualitative study. BJOG. 2013;120:362-70.
- 30. Bartley, M (2003) Health Inequalities: An introduction to theories, concepts and methods. Bristol: The Polity Press. CSDH (World Health Organisation) closing the Gap in a Generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organisation.
- 31. Naughton F, Prevost AT, Gilbert H, Sutton S. Randomized controlled trial evaluation of a tailored leaflet and SMS text message self-help intervention for pregnant smokers (MiQuit). Nicotine Tob Res. 2012;14(5):569-77.
- 32. McBride CM, Pirie PL, Curry SJ. Postpartum relapse to smoking: a prospective study. Health Educ Res. 1992;7:381-90.
- 33. Bryant J, Passey ME, Hall AE, Sanson-Fisher RW. A systematic review of the quality of reporting in published smoking cessation trials for pregnant women: an explanation for the evidence-practice gap? Implement Sci. 2014;9:94.
- 34. Coleman-Cowger VH. Smoking cessation intervention for pregnant women: a call for extension to the postpartum period. Maternal-Child Health J. 2012;16:937-40.
- 35. Flemming K, Graham H, Heirs M, Fox D, Sowden A. Smoking in pregnancy: a systematic review of qualitative research of women who commence pregnancy as smokers. J Adv Nurs. 2013;69:1023-36.
- 36. Stotts AL, DiClemente CC, Carbonari JP, Mullen PD. Pregnancy smoking cessation: a case of mistaken identity. Addict Behav. 1996;21(4):459-71.
- 37. Lawrence T, Aveyard P, Cheng KK, Griffin C, Johnson C, Croghan E. Does stage-based smoking cessation advice in pregnancy result in long term quitters? 18-month postpartum follow-up of a randomized controlled trial. Addiction. 2005;100(1):107-16.
- 38. Hill S, Young D, Briley A, Carter J, Lang R. Baby be Smoke free: Teenage smoking cessation pilot. Brit J of Midwifery. 2013;21(7):485-91.
- 39. Albrecht S, Payne L, Stone CA, Reynolds MD. A preliminary study of the use of peer support in smoking cessation programs for pregnant adolescents. J Am Acad Nurse Pract. 1998;10(3):119-25.
- 40. Malchodi CS, Oncken C, Dornelas EA, Caramanica L, Gregonis E, Curry SL. The effects of peer counseling on smoking cessation and reduction. Obstet Gynecol. 2003;101(3):504-10.
- 41. Solomon LJ, Secker-Walker RH, Flynn BS, Skelly JM, Capeless EL. Proactive telephone peer support to help pregnant women stop smoking. Tob Control. 2000;9 Suppl 3:III72-4.
- 42. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health. A systematic review. J Amer Med Assoc. 2007;298(19):2296-304.
- 43. Rooney B, Smalley K, Larson J, Havens S. Is knowing enough? Increasing physical activity by wearing a pedometer. Wisconsin Med J. 2003;102:31-6.
- 44. Downs DS, LeMasurier GC, DiNallo JM. Baby steps: pedometer-determined and self-reported leisure-time exercise behaviours of pregnant women. J Phys Act Health. 2009;6:63-72.
- 45. Ussher M, Aveyard P, Coleman T, Straus L, West R, Marcus B, et al. Physical activity as an aid to smoking cessation during pregnancy: two feasibility studies. BMC Public Health. 2008;8:328.
- 46. Higgins ST, Washio Y, Heil SH, Solomon LJ, Gaalema DE, Higgins TM, et al. Financial incentives for smoking cessation among pregnant and newly postpartum women. Prev Med. 2012;55:27.
- 47. Tappin D, Bauld L, Purves D, Boyd K, Sinclair L, MacAskill S, McKell J, Friel B, McConnachie A, de Caestecker L, Tannahill C, Radley A, Coleman T. Cessation in Pregnancy Incentives Trial Team. BMJ. 2015;350:h134.
- 48. Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ. 2008;336:1281-3.
- 49. West R. Smoking cessation interventions in pregnancy: guidance to purchasers and providers. London: Health Education Authority; 1994.
- 50. Artal M, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Brit J Sports Med. 2003;37:6-12.
- 51. Naughton F, Toby A, Sutton S. Self-help smoking cessation interventions in pregnancy: a systematic review and meta-analysis. Addiction. 2008;103:566-79.
- 52. Cargo M, Mercer S. The value and challenges of participatory research: strengthening its practice. Annu Rev Public Health. 2008;29:24.1-24.26.
No similar publications.