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Hassanein ZM, Murray RL, Bogdanovica I, Langley T. Healthcare Professionals' Knowledge, Attitudes and Counselling Practice Regarding Prevention of Secondhand Smoke Exposure Among Pregnant Women/Children in Assiut, Egypt. Int J Public Health 2022; 67:1605073. [PMID: 36387288 PMCID: PMC9661921 DOI: 10.3389/ijph.2022.1605073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives and Methods: A cross sectional study of HCPs working in public MCH clinics in Assiut city was conducted to explore their knowledge, attitudes and counselling practices regarding prevention of SHS exposure among pregnant women and children. Descriptive and regression analyses were performed. Results: 367 HCPs participated in the study, 12% of whom were smokers. The majority were nurses (45%). A considerable proportion of HCPs reported being exposed to SHS in workplace (70%) and home (52%). About half HCP reported high SHS knowledge (56%), supportive attitude towards preventing SHS exposure (53%), and having good counselling practice regarding SHS exposure (52%). Being a GP and serving urban communities were significantly associated with high knowledge. Being female, serving a rural population, receiving training on smoking cessation services, not being exposed to SHS at home, and having a supportive attitude towards prevention of SHS exposure were significantly associated with good counselling practice. Conclusion: Awareness, attitudes and counselling practice of HCPs should be improved. Training for HCPs and enforcement of smoke free polices are needed to improve awareness and facilitate changes in social norms.
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Affiliation(s)
- Zeinab M. Hassanein
- Public Health Department, Faculty of Medicine, Assiut University, Assiut, Egypt,School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, United Kingdom,*Correspondence: Zeinab M. Hassanein,
| | - Rachael L. Murray
- School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, United Kingdom,SPECTRUM Consortium, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Ilze Bogdanovica
- School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Tessa Langley
- School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, United Kingdom,SPECTRUM Consortium, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, United Kingdom
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Gould GS, Twyman L, Stevenson L, Gribbin GR, Bonevski B, Palazzi K, Bar Zeev Y. What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis. BMJ Open 2019; 9:e026037. [PMID: 31427313 PMCID: PMC6701616 DOI: 10.1136/bmjopen-2018-026037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 06/19/2019] [Accepted: 07/09/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pregnancy is an opportunity for health providers to support women to stop smoking. OBJECTIVES Identify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy. DESIGN A systematic review synthesising original articles that reported on (1) prevalence of health providers' performing the 5As ('Ask', 'Advise', 'Assess', 'Assist', 'Arrange'), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care. DATA SOURCES MEDLINE, EMBASE, CINAHL and PsycINFO databases searched using 'smoking', 'pregnancy' and 'health provider practices'. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies included any design except interventions (self-report, audit, observed consultations and women's reports), in English, with no date restriction, up to June 2017. PARTICIPANTS Health providers of any profession. DATA EXTRACTION, APPRAISAL AND ANALYSIS Data were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, 'often/always' and 'always/all'. Meta-regressions were performed of 5As for 'often/always'. RESULTS Of 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices 'often/always' were: 'Ask' (n=9) 91.6% (95% CI 88.2% to 95%); 'Advise' (n=7) 90% (95% CI 72.5% to 99.3%), 'Assess' (n=3) 79.2% (95% CI 76.5% to 81.8%), 'Assist (cessation support)' (n=5) 59.1% (95% CI 56% to 62.2%), 'Arrange (referral)' (n=6) 33.3% (95% CI 20.4% to 46.2%) and 'prescribing NRT' (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I2) was 95.9%-99.1%. Meta-regressions for 'Arrange' were significant for year (p=0.013) and country (p=0.037). CONCLUSIONS Health providers 'Ask', 'Advise' and 'Assess' most pregnant women about smoking. 'Assist', 'Arrange' and 'prescribing NRT' are reported at lower rates: strategies to improve these should be considered. PROSPERO REGISTRATION NUMBER CRD42015029989.
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Affiliation(s)
- Gillian Sandra Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Laura Twyman
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Leah Stevenson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Gabrielle R Gribbin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Yael Bar Zeev
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
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Preconception and Prenatal Smoking among Maine Women: Defining Risk and Determining the Impact of Efforts by Care Providers to Promote Cessation. J Smok Cessat 2017. [DOI: 10.1017/jsc.2017.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Smoking before and during pregnancy is a risk for women and their babies, but encouraging tobacco abstinence challenges practitioners.Aims: We define correlates of tobacco use around pregnancy and determine the impact of providers’ efforts to encourage abstinence.Methods: We analysed responses (2000 – 2010) from the Pregnancy Risk Assessment Monitoring System questionnaire for Maine, United States, a state with higher than average smoking rates. We performed multivariable logistic regression analysis with demographic and behavioural independent variables, and smoking in the last 3 months before and in the last 3 months of pregnancy as dependent variables.Results: Of 12,409 questionnaire responders, 32% smoked before pregnancy; 60.5% of these women continued during pregnancy. Women were more likely to smoke before pregnancy and to continue during pregnancy if they had a previous birth, were unmarried, had ≤ a high school education, or had a household income ≤ $20,000/year. Pre-pregnancy smokers were more likely to continue smoking during pregnancy if their gestational weight gain was less than recommended and, surprisingly, if they recalled a provider discussion about smoking cessation.Conclusions: We identify women at risk for smoking before and during pregnancy and demonstrate that current tobacco abstinence interventions by providers may not always be effective.
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Tzelepis F, Daly J, Dowe S, Bourke A, Gillham K, Freund M. Supporting Aboriginal Women to Quit Smoking: Antenatal and Postnatal Care Providers’ Confidence, Attitudes, and Practices. Nicotine Tob Res 2017; 19:642-646. [DOI: 10.1093/ntr/ntw286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/15/2016] [Indexed: 11/14/2022]
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Massaquoi LD, Edwards NC. A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15769-81. [PMID: 26690461 PMCID: PMC4690954 DOI: 10.3390/ijerph121215018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 10/25/2015] [Accepted: 11/27/2015] [Indexed: 11/16/2022]
Abstract
Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians' environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians' attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians' self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients' responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.
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Colomar M, Tong VT, Morello P, Farr SL, Lawsin C, Dietz PM, Aleman A, Berrueta M, Mazzoni A, Becu A, Buekens P, Belizán J, Althabe F. Barriers and promoters of an evidenced-based smoking cessation counseling during prenatal care in Argentina and Uruguay. Matern Child Health J 2015; 19:1481-9. [PMID: 25500989 PMCID: PMC4442744 DOI: 10.1007/s10995-014-1652-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Argentina and Uruguay, 10.3 and 18.3 %, respectively, of pregnant women smoked in 2005. Brief cessation counseling, based on the 5A's model, has been effective in different settings. This qualitative study aims to improve the understanding of factors influencing the provision of smoking cessation counseling during pregnancy in Argentina and Uruguay. In 2010, we obtained prenatal care providers', clinic directors', and pregnant smokers' opinions regarding barriers and promoters to brief smoking cessation counseling in publicly-funded prenatal care clinics in Buenos Aires, Argentina and Montevideo, Uruguay. We interviewed six prenatal clinic directors, conducted focus groups with 46 health professionals and 24 pregnant smokers. Themes emerged from three issue areas: health professionals, health system, and patients. Health professional barriers to cessation counseling included inadequate knowledge and motivation, perceived low self-efficacy, and concerns about inadequate time and large workload. They expressed interest in obtaining a counseling script. Health system barriers included low prioritization of smoking cessation and a lack of clinic protocols to implement interventions. Pregnant smokers lacked information on the risks of prenatal smoking and underestimated the difficulty of smoking cessation. Having access to written materials and receiving cessation services during clinic waiting times were mentioned as promoters for the intervention. Women also were receptive to non-physician office staff delivering intervention components. Implementing smoking cessation counseling in publicly-funded prenatal care clinics in Argentina and Uruguay may require integrating counseling into routine prenatal care and educating and training providers on best-practices approaches.
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Affiliation(s)
- Mercedes Colomar
- Unidad de Investigación Clínica y Epidemiológica Montevideo, Hosp Clinicas, Av Italia s/n, Montevideo, Uruguay,
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Which role do midwives and gynecologists have in smoking cessation in pregnant women? - A study in Flanders, Belgium. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:66-73. [PMID: 25998873 DOI: 10.1016/j.srhc.2014.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/20/2014] [Accepted: 12/30/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The objectives of our study were (1) to explore knowledge, beliefs and practice among midwives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women. METHOD We performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A's framework (Ask-Advise-Assess-Assist-Arrange). RESULTS The national smoking cessation policy seemed to be insufficiently known. "Ask" and "Advise" were part of a standard prenatal consultation, the next three steps were rarely implemented. Participants had a negative image of "the smoking pregnant woman": a low educated woman with a smoking partner and "bad examples" in their history. Reported barriers were fear of provoking resistance and lack of time and communication skills regarding smoking cessation. CONCLUSIONS These findings suggest that training in communication skills and dealing with resistance should be offered, i.e. by using motivational interviewing. It could be considered that a trained midwife or tobaccologist is part of an obstetrical team or that the AAR-method (Ask-Advise-Refer) is used instead of the 5 A's framework.
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Healthcare Providers’ Views on Digital Smoking Cessation Interventions for Pregnant Women. J Smok Cessat 2014. [DOI: 10.1017/jsc.2014.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Digital smoking cessation aids may benefit pregnant smokers who do not wish to receive face-to-face behavioural support. Healthcare providers (HCPs) who interact with pregnant smokers may have valuable insights into their development and use.Aims: To explore HCPs’ views of using digital smoking cessation interventions with pregnant women in order to inform the design and delivery of digital smoking cessation interventions.Methods: Two structured focus groups were conducted with HCPs (n = 16) who provided smoking cessation support for pregnant women in England. Discussions covered participants’ general views about digital smoking cessation interventions, the potential of such interventions for smoking cessation support for pregnant smokers, and recommendations for future intervention development. Transcripts were analysed thematically.Results: HCPs identified a variety of ways in which digital interventions could benefit pregnant smokers, such as by providing anonymity, offering consistent quality of advice, and being available on demand. The identified limitations of digital smoking cessation interventions included lack of access among those most economically disadvantaged, the need for high levels of self-motivation, and lack of human contact. Addressing pregnant smokers’ negative perceptions of smoking cessation support, providing rewarding experiences, and tailoring the intervention to smokers’ level of confidence were among HCPs’ recommendations.Conclusions: HCPs indicated that digital interventions offer a range of potential benefits that could make them useful for pregnant smokers. Nonetheless, important limitations and recommendations regarding their design and delivery were identified and these need to be addressed in intervention development.
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Arrish J, Yeatman H, Williamson M. Midwives and nutrition education during pregnancy: a literature review. Women Birth 2013; 27:2-8. [PMID: 23562582 DOI: 10.1016/j.wombi.2013.02.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 01/31/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This review explored the extent to which the role of midwives in nutrition education during pregnancy has been reported in the literature and areas requiring further research were identified. REVIEW METHOD A review of the literature was undertaken. Articles included in the review were published in English, in scholarly journals, and provided information about the knowledge, education, and attitudes of midwives towards nutrition during pregnancy. RESULTS AND DISCUSSION Few studies were identified. The included studies were exploratory and descriptive. Studies had reported that midwives lacked a basic knowledge of nutrition requirements during pregnancy. This might be attributed to inadequate nutrition education provided in both undergraduate and postgraduate midwifery programmes. The nutrition education components of midwifery courses were not identified within the studies reviewed. CONCLUSION Limited international or Australian research is available that reports on the role of midwives in nutrition education during pregnancy and the nutrition content of midwifery curricula. This represents an important omission in midwives capacity to support the health of pregnant women and their babies. More research is required to explore the educational needs of midwives to enhance nutritional care for pregnant women.
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Affiliation(s)
- Jamila Arrish
- School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, New South Wales, Australia.
| | - Heather Yeatman
- School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, New South Wales, Australia
| | - Moira Williamson
- School of Nursing, Midwifery and Indigenous Health, Faculty of Health and Behavioural Sciences, University of Wollongong, New South Wales, Australia; Higher Education Division, Central Queensland University, 90 Goodchap Street, Noosaville, 4566, Queensland, Australia
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Abstract
Introduction: While numerous barriers to smoking cessation in pregnancy have been identified, less is known about the role of pregnant smokers’ beliefs in promoting and inhibiting abstinence. This study explored these beliefs and how they might interact with psychosocial factors related to pregnancy and antenatal care.Methods: In-depth face-to-face semi-structured interviews were conducted with 20 women with experience of prenatal smoking. Grounded theory and the constant comparative approach guided the analysis towards a theoretical explanation of the women's experiences.Results: Cognitive dissonance generated by the discrepancy between smoking-related prenatal harm beliefs and continued smoking was a strong motivator to quit. However, difficulty in quitting led many to resolve this dissonance by endorsing disengagement beliefs which downplayed the threat of smoking. Four main types of disengagement belief were identified. The tendency to endorse disengagement beliefs appeared to be influenced by two factors: uncertainty about how smoking caused foetal harm and reassurance from health professionals and others that reduced smoking was sufficient for harm minimisation.Conclusions: Disengagement belief endorsement is common among pregnant smokers and enables the justification of continued smoking, potentially hindering efforts to quit. Increased promotion of complete abstinence by antenatal care professionals and health education interventions targeting risk comprehension and disengagement belief endorsement should be considered to promote greater efforts to quit among pregnant smokers.
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Knowledge, attitudes and other factors associated with assessment of tobacco smoking among pregnant Aboriginal women by health care providers: a cross-sectional survey. BMC Public Health 2012; 12:165. [PMID: 22397580 PMCID: PMC3311138 DOI: 10.1186/1471-2458-12-165] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 03/07/2012] [Indexed: 11/19/2022] Open
Abstract
Background As with many Indigenous peoples, smoking rates among Aboriginal Australians are considerably higher than those of the non-Indigenous population. Approximately 50% of Indigenous women smoke during pregnancy, a time when women are more motivated to quit. Antenatal care providers are potentially important change agents for reducing the harms associated with smoking, yet little is known about their knowledge, attitudes or skills, or the factors associated with providing smoking cessation advice. Methods This paper aimed to explore the knowledge and attitudes of health care providers caring for pregnant Australian Aboriginal women with regard to smoking risks and cessation; and to identify factors associated with self-reported assessment of smoking. A cross-sectional survey was undertaken with 127 staff providing antenatal care to Aboriginal women from two jurisdictions: the Northern Territory and New South Wales, Australia. Measures included respondents' estimate of the prevalence of smoking among pregnant women; optimal and actual assessment of smoking status; knowledge of risks associated with antenatal smoking; knowledge of smoking cessation; attitudes to providing cessation advice to pregnant women; and perceived barriers and motivators for cessation for pregnant women. Results The median provider estimate of the smoking prevalence was 69% (95%CI: 60,70). The majority of respondents considered assessment of smoking status to be integral to antenatal care and a professional responsibility. Most (79%) indicated that they assess smoking status in 100% of clients. Knowledge of risks was generally good, but knowledge of cessation was poor. Factors independently associated with assessing smoking status among all women were: employer service type (p = 0.025); cessation knowledge score (p = 0.011); and disagreeing with the statement that giving advice is not worth it given the low level of success (p = 0.011). Conclusions Addressing knowledge of smoking risks and cessation counselling is a priority and should improve both confidence and ability, and increase the frequency and effectiveness of counselling. The health system must provide supports to providers through appropriate policy and resourcing, to enable them to address this issue.
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The Scottish Trial of Refer or Keep (the STORK study): midwives' intrapartum decision making. Midwifery 2011; 27:104-11. [PMID: 20137838 DOI: 10.1016/j.midw.2009.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 11/23/2009] [Accepted: 12/06/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVES to explore midwives' intrapartum referral decisions in relation to their dispositional attitude towards risk. DESIGN a web-based correlation study examined the association between midwife's personality (personal risk tendency), place of work (location), years of experience and the timing of their decisions to make referrals (referral score) in a series of fictitious case scenarios (vignettes). PARTICIPANTS 102 midwives providing labour care in both consultant-led units (CLU) and community maternity units (CMU) from four Scottish health board areas. ANALYSIS a correlational analysis was carried out to test the association between total risk scores and midwives' referral scores. Between-group comparisons were also conducted for experienced vs inexperienced midwives, midwives practising in CLU vs CMU settings and between the four health board areas. FINDINGS despite being presented with identical information in the vignettes, midwives made a wide range of referral decisions. There was no association between referral scores and measures of risk, personality or years of experience. No statistically significant difference between the referral scores of midwives working in CLUs or CMUs was observed. However, a statistically significant difference did emerge between the four health board areas, with midwives from one area making referrals at a significantly earlier stage. The maternity services in this area had experienced several high profile adverse events prior to this study; this may have influenced their referral behaviour (the availability heuristic), in terms of making more cautious decisions. KEY CONCLUSIONS there was no evidence that variability in the range of referral decisions was due to personality factors, risk propensity, experience or whether the midwife worked in a CLU or CMU. Local factors such as recent adverse events may significantly influence subsequent referral behaviour. Further research is required to identify why the midwives showed so much unexplained variability in their responses to the vignettes.
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Abatemarco DJ, Steinberg MB, Delnevo CD. Midwives' Knowledge, Perceptions, Beliefs, and Practice Supports Regarding Tobacco Dependence Treatment. J Midwifery Womens Health 2010; 52:451-7. [PMID: 17826707 DOI: 10.1016/j.jmwh.2007.03.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Clinical practice guidelines and evidence-based reviews confirm the efficacy of tobacco dependence treatment for pregnant women. The purpose of this study was to examine tobacco dependence treatment practices among certified nurse-midwives who treat pregnant women who smoke. Midwives were surveyed to determine knowledge, perceptions, and beliefs about tobacco cessation treatment and to identify practice environmental factors that support treatment practices. Half of all midwives had not heard of the US Public Health Service Guidelines (5 A's) to assist smokers in cessation treatment. We found varying levels of adherence to the clinical practice guidelines. Nearly all midwives routinely ask, advise, and assess; while fewer encourage patients to set a quit date or discuss medication options (assist) and perform follow-up activities (arrange). Barriers significantly associated with clinical tobacco treatment practice are lack of training and competing priorities in the visit. One-office support, a system in place to provide smoking cessation information and resources, was associated with increased practice. In summary, midwives believe they should be providing tobacco dependence treatment, yet they identify a need for training. The findings of this study also indicate that sustained practice change, which includes the entire practice environment, should be targeted to enhance tobacco dependence treatment.
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Affiliation(s)
- Diane J Abatemarco
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Population-based smoking cessation in women post partum: adherence to motivational interviewing in relation to client characteristics and behavioural outcomes. Midwifery 2010; 26:202-10. [DOI: 10.1016/j.midw.2008.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 03/17/2008] [Accepted: 04/11/2008] [Indexed: 11/11/2022]
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Okoli CT, Greaves L, Bottorff JL, Marcellus LM. Health Care Providers' Engagement in Smoking Cessation With Pregnant Smokers. J Obstet Gynecol Neonatal Nurs 2010; 39:64-77. [DOI: 10.1111/j.1552-6909.2009.01084.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sarna L, Bialous SA, Wells M, Kotlerman J, Wewers ME, Froelicher ES. Frequency of nurses' smoking cessation interventions: report from a national survey. J Clin Nurs 2009; 18:2066-77. [PMID: 19638062 DOI: 10.1111/j.1365-2702.2009.02796.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe the frequency of nurses' delivery of tobacco cessation interventions ('Five A's': Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses' awareness of the Tobacco Free Nurses initiative. BACKGROUND Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control. DESIGN Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate). METHOD A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse's delivery of smoking cessation interventions ('Five A's') was adapted for use on the web. RESULTS The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2.24). CONCLUSIONS Nurses' delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients' quit attempts.
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Affiliation(s)
- Linda Sarna
- School of Nursing, University of California, Los Angeles, CA 90095-6916, USA.
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Smoking cessation counselling for pregnant and postpartum women among midwives, gynaecologists and paediatricians in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:96-107. [PMID: 19440272 PMCID: PMC2672345 DOI: 10.3390/ijerph6010096] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 12/23/2008] [Indexed: 11/17/2022]
Abstract
The incorporation of guidelines for the treatment of tobacco smoking into routine care requires positive attitudes, counselling skills and knowledge about additional help available for smokers. The study assesses performance of smoking cessation intervention, attitudes, training status and knowledge about additional help for smokers in the care for pregnant and parenting women by midwives, gynaecologists and paediatricians. A survey of all midwives, gynaecologists and paediatricians registered for primary medical care in the federal state Saarland, Germany, was conducted. Participation in the postal questionnaires was 85 %. Depending on profession, 90 % to 100 % see smoking cessation counselling as their assignment, 17 % to 80 % screen for, 48 % to 90 % document smoking status, and 55 % to 76 % offer brief or extensive counselling. 61 % to 87 % consider training to enhance their knowledge and/or counselling skills necessary. The compliance of providers with the necessity to give support in smoking cessation is very high. However, the current status of cessation counselling does not sufficiently correspond to the evidence based requirements. Reports in medical press and advanced training courses should support health care providers and establish smoking as an inherent topic of the anamnesis and treatment of current and former pregnant or parenting smokers.
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Hannöver W, Thyrian JR, Röske K, Grempler J, Rumpf HJ, John U, Hapke U. Smoking cessation and relapse prevention for postpartum women: results from a randomized controlled trial at 6, 12, 18 and 24 months. Addict Behav 2009; 34:1-8. [PMID: 18804331 DOI: 10.1016/j.addbeh.2008.07.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 06/27/2008] [Accepted: 07/29/2008] [Indexed: 11/29/2022]
Abstract
AIM To test the efficacy of an aid to cessation/relapse prevention intervention for women postpartum. METHOD Two-armed randomized controlled trial. Follow-ups at 6, 12, 18, and 24 months, screenings on maternity wards. Intervention group received face-to-face counseling 40 days postpartum plus telephone counseling calls 4 and 12 weeks later. Control group received usual care plus self-help material for each parent. RESULTS With regard to smoking cessation, 4 week point prevalence abstinent rates were higher in the treatment group at 6, 12, and 18 months (7% vs. 1%, 7% vs. 2%, and 9% vs. 1%, respectively). Sustained abstinence was higher in the treatment group at 6 months follow-up (3% vs. 0%). No difference was observed with regard to relapse prevention. DISCUSSION Regarding aid to cessation we observed small effects, regarding relapse prevention no effect. In order to capitalize on the opportunity childbirth poses with regard to smoking, theories on relapse prevention in smoking cessation that guide in designing interventions are needed.
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Affiliation(s)
- Wolfgang Hannöver
- Ernst-Moritz-Arndt-University Greifswald, Institute for Medical Psychology, Walther-Rathenau-Str. 48, D-17487 Greifswald, Germany.
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Bull L, Whitehead E. Smoking cessation intervention with pregnant women and new parents: A survey of health visitors, midwives and practice nurses. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.jnn.2006.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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