Dr Jo Longman Research Fellow, University Centre for Rural Health, University of Sydney, Australia
Abstract
Introduction
Australian guidelines (using the “5As”) recommend routine assessment of smoking status and intensive support and counselling for cessation for all pregnant women. However, implementation of this support is suboptimal. The reasons for this are unclear.
Methods
Semi-structured interviews were conducted with 27 key informants, midwives and obstetricians working in antenatal care in the NSW public health system. Interviews were comprehensive, assessing the influence of 14 separate domains (of the Theoretical Domains Framework) on clinician behaviour, and elicited participants’ perceptions of the barriers and enablers to implementing the guidelines. Findings were analysed thematically.
Results
Computer and paper-based systems supported or hindered guideline implementation by prompting or scaffolding action or not. Continuity in care impacted on implementation, as did training (linked to participants’ knowledge, particularly of NRT), and time restrictions connected to priorities in antenatal care visits. Whilst participants articulated clear benefits of antenatal smoking cessation, some also perceived raising smoking cessation as a ‘difficult conversation’ potentially threatening to the relationship with their clients.
Conclusion
The evidence-practice gap in smoking cessation in pregnancy is an international problem. The findings of this study will help develop interventions to support clinicians to improve guideline implementation.
Source of funding: NSW Cancer Institute and the National Health and Medical Research Council.
