smoking cessation in pregnancy – barriers & facilitators
DESCRIPTION
Smoking Cessation In Pregnancy – Barriers & facilitators. Fiona Dunlop Health Improvement Lead (Tobacco) With thanks to Jacki Gordon & Associates for undertaking the evaluation. Presentation overview. Background Methods Quantitative findings Qualitative findings Recommendations. - PowerPoint PPT PresentationTRANSCRIPT
Smoking Cessation In Pregnancy – Barriers & facilitators
Smoking Cessation In Pregnancy – Barriers & facilitatorsFiona DunlopHealth Improvement Lead (Tobacco)
With thanks to Jacki Gordon & Associates for undertaking the evaluation
Fiona DunlopHealth Improvement Lead (Tobacco)
With thanks to Jacki Gordon & Associates for undertaking the evaluation
Presentation overviewPresentation overview
Background
Methods
Quantitative findings
Qualitative findings Recommendations
Background
Methods
Quantitative findings
Qualitative findings Recommendations
SPS pathwaySPS pathway
1. CO testbooking
4. Appointmentarranged
5. Face to faceintervention
2. Electronicreferral
3. Opt in/outcall
6. Telephonesupport
7. 3/12 monthFollow up
Other referrals•Clinic•Midwife•Self•GP/SCI•In-patient
RationaleRationale
2521
1665
1372
908 812
289
0
500
1000
1500
2000
2500
3000
Referrals Contacted Arranged appointment
Attended Set quit date Quit @ 4 weeks
SPS Activity 1st April 2011 to 31st March 2012
Condition 1: Why do women arrange an appointment with the SPS and then not attend?
RationaleRationale
2521
1665
1372
908 812
289
0
500
1000
1500
2000
2500
3000
Referrals Contacted Arranged appointment
Attended Set quit date Quit @ 4 weeks
SPS Activity 1st April 2011 to 31st March 2012
Condition 2: Why do women who smoke and attend their appointment withdraw from the service before setting a quit date?
RationaleRationale
2521
1665
1372
908 812
289
0
500
1000
1500
2000
2500
3000
Referrals Contacted Arranged appointment
Attended Set quit date Quit @ 4 weeks
SPS Activity 1st April 2011 to 31st March 2012
Condition 3: Why do women who have set a quit date withdraw from the SPS?
RationaleRationale
2521
1665
1372
908 812
289
0
500
1000
1500
2000
2500
3000
Referrals Contacted Arranged appointment
Attended Set quit date Quit @ 4 weeks
SPS Activity 1st April 2011 to 31st March 2012
Condition 4: Why women who attend the service and stop smoking are successful in their quit attempts?
MethodsMethods
Short online literature review
Brief analysis of the SPS records to guide selection of sample and identify factors associated with disengagement
One-to-one telephone interviews
Short online literature review
Brief analysis of the SPS records to guide selection of sample and identify factors associated with disengagement
One-to-one telephone interviews
SPS data analysisSPS data analysis
Top line findings:•Low SIMD associated with disengagement and poorer quit outcomes•PNBS referrals less likely to attend•PNBS and clinic referrals less likely to set a quit date
Top line findings:•Low SIMD associated with disengagement and poorer quit outcomes•PNBS referrals less likely to attend•PNBS and clinic referrals less likely to set a quit date
Characteristics of interviewees (n = 30)Characteristics of interviewees (n = 30) Referral Source SIMD
PNBS
ClinicMid-wife
Self 1 2 3
Condition 1 8 - - - 7 1 -
Condition 2 2 2 2 - 5 1 -
Condition 3 6 1 1 - 3 5 -
Condition 4 5 2 - 1 3 3 2
Women’s ‘smoking cessation journeys’ are complex and highly individual.
Women’s ‘smoking cessation journeys’ are complex and highly individual.
There are many factors that can impact on adherence to the service and success
Views of service...Views of service...
Overwhelming, positive re service and advisors.
Non-judgemental approach valued. Feeling comfortable with the advisors.
Receptive because advisors were not ‘preachy’.
Overwhelming, positive re service and advisors.
Non-judgemental approach valued. Feeling comfortable with the advisors.
Receptive because advisors were not ‘preachy’.
Condition 1: Why do women arrange an appointment with the SPS and then not attend?
No contact details for service
Condition 2: Why do women who smoke and attend their appointment withdraw from the service before setting a quit date?
Condition 3: Why do those who have set a quit date withdraw from the SPS?
Things get in the way!
No ready - motivation Other issues e.g.
PovertyAddictions
Boredom and stress Barriers and challenges
not always discussed/addressed
Timing of phone calls – disengagement
No contact details
No ready - motivation Other issues e.g.
PovertyAddictions
Boredom and stress Barriers and challenges
not always discussed/addressed
Timing of phone calls – disengagement
No contact details
Smoking reduction…Smoking reduction… Many reduce the number of cigarettes smoked - all
they can achieve but effort not valued Feel Service is about stopping altogether– which it is. Embarrassed to maintain contact if still smoking
NRT Quantitative analysis – less likely to quit using NRT –
50% data was missing May have high expectations? Conversely they will come of NRT too soon - side
effects or feelings that NRT was no longer needed it. Is our risk/benefit form contributing to this?
Many reduce the number of cigarettes smoked - all they can achieve but effort not valued
Feel Service is about stopping altogether– which it is. Embarrassed to maintain contact if still smoking
NRT Quantitative analysis – less likely to quit using NRT –
50% data was missing May have high expectations? Conversely they will come of NRT too soon - side
effects or feelings that NRT was no longer needed it. Is our risk/benefit form contributing to this?
Other issuesOther issues
Variability in ongoing support from midwives Midwives and other health professionals not
knowing how women got on Missing / not picking up calls from SPS Relapse
Variability in ongoing support from midwives Midwives and other health professionals not
knowing how women got on Missing / not picking up calls from SPS Relapse
Condition 4: Why women who attend the service and stop smoking are successful in their quit attempts?
RecommendationsRecommendations
Recommendation 1:Inequalities sensitive practice
Recommendation 1:Inequalities sensitive practice
Finding: Women from lower SIMDs are more likely to
continue smoking in pregnancy
Recommendation: Review extent of / improve inequalities
sensitive practices address possibility of pre-attendance fears ensure advisors know about / display
sensitivity regarding the impact of social inequalities
Finding: Women from lower SIMDs are more likely to
continue smoking in pregnancy
Recommendation: Review extent of / improve inequalities
sensitive practices address possibility of pre-attendance fears ensure advisors know about / display
sensitivity regarding the impact of social inequalities
Recommendation 2:Information provisionRecommendation 2:Information provision
Finding: Women lacked SPS contact details Unaware SPS available in number of locations.
Recommendation: All referrals should be given the phone number (and
hours) of the service. Enter this in hand held records. At booking, give all women leaflet about SPS service -
reinforce the service values (non-judgemental, friendly etc.) and include the phone number
Finding: Women lacked SPS contact details Unaware SPS available in number of locations.
Recommendation: All referrals should be given the phone number (and
hours) of the service. Enter this in hand held records. At booking, give all women leaflet about SPS service -
reinforce the service values (non-judgemental, friendly etc.) and include the phone number
Recommendation 3: Referral and appointment
practices
Recommendation 3: Referral and appointment
practicesFinding: Feeling pushed into attending the service/ pressured
quitting associated with disengagement /failing to quit.
Recommendations: Midwives should explain how the service operates,
promote service and encourage women to attend. - Requires SPS clarity on who the service is for (just
those ready to quit?) - Consider potential for midwives explaining
smoking risks/quit benefits and addressing ambivalence?
Finding: Feeling pushed into attending the service/ pressured
quitting associated with disengagement /failing to quit.
Recommendations: Midwives should explain how the service operates,
promote service and encourage women to attend. - Requires SPS clarity on who the service is for (just
those ready to quit?) - Consider potential for midwives explaining
smoking risks/quit benefits and addressing ambivalence?
Recommendation 3 cont..Recommendation 3 cont..
Advisors setting appointments must assess motivation in a manner that recognises women may find it hard to say that they are not ready to stop smoking.
While advisors may wish to stress the benefits of quitting as soon as possible, they need to accept and work within the constraints of women’s readiness to change when setting quit dates.
Advisors setting appointments must assess motivation in a manner that recognises women may find it hard to say that they are not ready to stop smoking.
While advisors may wish to stress the benefits of quitting as soon as possible, they need to accept and work within the constraints of women’s readiness to change when setting quit dates.
Recommendation 4: Overcoming boredom and stress
Recommendation 4: Overcoming boredom and stress
Recommendation:Advisors need to identify whether boredom and
stress are barriers and do so in ongoing manner
Provide tailored advice/tips relevant to women’s lives
upskilling in stress management and CBT??
Recommendation:Advisors need to identify whether boredom and
stress are barriers and do so in ongoing manner
Provide tailored advice/tips relevant to women’s lives
upskilling in stress management and CBT??
Recommendation 5: Protocol for reduced
consumption
Recommendation 5: Protocol for reduced
consumptionFinding: Value advisors maintaining contact and
encouraging women struggling to quit Women avoiding talking to advisors when
unsuccessful in quit attempts.Recommendation:Clear SPS protocol for women who fail to quit
completely detailing level of support women will be given. This needs to be communicated.
Finding: Value advisors maintaining contact and
encouraging women struggling to quit Women avoiding talking to advisors when
unsuccessful in quit attempts.Recommendation:Clear SPS protocol for women who fail to quit
completely detailing level of support women will be given. This needs to be communicated.
Recommendation 6:Discontinuation of NRT
Recommendation 6:Discontinuation of NRT
Findings:Discontinuation was common and use possibly associated with poorer outcomes?
Recommendation:If pattern is confirmed, it will be important to identify the mechanisms that underpin this Irrespective:Important to keep door open to SPS even if stop NRT useConsider feasibility of SPS offering a review visit
Findings:Discontinuation was common and use possibly associated with poorer outcomes?
Recommendation:If pattern is confirmed, it will be important to identify the mechanisms that underpin this Irrespective:Important to keep door open to SPS even if stop NRT useConsider feasibility of SPS offering a review visit
Recommendation 7:More joined up working
Recommendation 7:More joined up working
Finding:Others (midwives) often unaware how women got on
Recommendations:Consider a feedback mechanismOpportunities for others to provide encouragement e.g. midwives, radiographers etc?Clear and sustained referral mechanisms from FNP?
Finding:Others (midwives) often unaware how women got on
Recommendations:Consider a feedback mechanismOpportunities for others to provide encouragement e.g. midwives, radiographers etc?Clear and sustained referral mechanisms from FNP?
Recommendation 8:Preventing relapse
Recommendation 8:Preventing relapse
Finding: Many had quit when previously pregnant
Recommendation:Expand reasons for not smokingConsider how topass the baton to postnatal services
Finding: Many had quit when previously pregnant
Recommendation:Expand reasons for not smokingConsider how topass the baton to postnatal services
Contact detailstelephone: 0141 201 4520
email: [email protected]: www.nhsggcsmokefree.org.uk