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Agràs-Guàrdia M, Martínez-Torres S, Satué E, Granado-Font E, Pallejà-Millán M, Patricio D, Leiva M, Rey-Reñones C, Martín-Luján F. Experiences of smoking and tobacco use during pregnancy: A qualitative study protocol. PLoS One 2024; 19:e0308781. [PMID: 39121101 PMCID: PMC11315274 DOI: 10.1371/journal.pone.0308781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/30/2024] [Indexed: 08/11/2024] Open
Abstract
Tobacco use during pregnancy is the main avoidable cause of morbidity and mortality both for pregnant women and their offspring. Between 12 and 22% of pregnant women in industrialized countries smoke during pregnancy, and 13% are unable to stop smoking. Pregnancy is considered an ideal opportunity to intervene and control tobacco use among smokers and their families. However, pregnant women experience barriers to quitting smoking, including social stigma and fear of being judged. Thus, it is necessary to develop interventions for smoking cessation adapted for pregnant women. This paper presents a qualitative study protocol to assess the barriers and facilitators of smoking cessation during pregnancy that female smokers encounter or perceive. It consists of a series of focus groups and individual interviews with female smokers who have been pregnant within the last five years. Participants will be recruited from the Sexual and Reproductive Health Care Services of the Camp de Tarragona. A group of 5-10 women who have been pregnant and tried to quit smoking over the last 5 years will be selected. The data will be collected by means of semistructured interviews. All interviews will be transcribed verbatim, coded and synthesized into categories and main themes. Thematic analysis will be conducted employing an iterative and reflexive approach. The results of this study will offer new perspectives on smoking interventions for pregnant women and enhance our comprehension of the main barriers to and facilitators of smoking cessation during pregnancy. This will contribute to the adaptation of the Tobbstop app, originally designed for the general public, to suit the needs of pregnant women. Consequently, the creation of targeted interventions will positively influence the health outcomes of both pregnant women and newborns. Trial registration: Clinicaltrials.gov ID: NCT05222958. The trial was registered 3 February 2022, at https://clinicaltrials.gov/ct2/show/NCT05222958.
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Affiliation(s)
- Maria Agràs-Guàrdia
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Primary Care Center Llibertat (Reus– 3), Reus, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
| | - Sara Martínez-Torres
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Eva Satué
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Ester Granado-Font
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Primary Care Center Horts de Miró (Reus– 4), Reus, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
| | - Meritxell Pallejà-Millán
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Demetria Patricio
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Sexual and Reproductive Health Care Unit (ASSIR), Reus, Spain
| | - Miriam Leiva
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Sexual and Reproductive Health Care Unit (ASSIR), Reus, Spain
| | - Cristina Rey-Reñones
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
| | - Francisco Martín-Luján
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
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Exploring experiences and needs of perinatal women in digital healthcare: A meta-ethnography of qualitative evidence. Int J Med Inform 2023; 169:104929. [PMID: 36435014 DOI: 10.1016/j.ijmedinf.2022.104929] [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: 04/08/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this review is to identify, appraise, and synthesize the available qualitative evidence on the experiences and needs of perinatal women by using digital technologies in healthcare. METHODS This review was consolidated following the eMERGe meta-ethnography reporting guidance. We conducted a comprehensive search in eight databases from inception to 12 October 2021. Published and unpublished qualitative and mixed-method studies published in English were included. The methodological quality was assessed using the critical appraisal skill program checklist. A meta-ethnographic synthesis was used according to Noblit and Hare's seven-step iterative process. RESULTS A total of 3,843 articles were retrieved, and 27 qualitative studies pertaining to 3,775 perinatal women from 13 countries across different ethnicities were included. Four overarching themes emerged for the aspect of experiences: (1) normalization of experience, (2) attainment of valuable knowledge, (3) empowerment and self-confidence boosting, and (4) beneficial features of digital platforms. For the aspect of needs, the derived themes included the following: (1) necessity of credible resources, (2) importance of personalization, (3) concern about cybersecurity, and (4) urging additional support. Our line-of-argument for interpreting the perinatal women's experiences can offer a much greater engagement in digital healthcare, while the findings on the perinatal women's needs can add value for improving the design of digital healthcare in the future. CONCLUSION This review offers a deeper understanding of the perinatal women's experiences and needs when using digital technologies in healthcare. Our findings provide meaningful recommendations for clinical practice and future research.
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Barroso-Hurtado M, Suárez-Castro D, Martínez-Vispo C, Becoña E, López-Durán A. Smoking Cessation Apps: A Systematic Review of Format, Outcomes, and Features. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11664. [PMID: 34770178 PMCID: PMC8583115 DOI: 10.3390/ijerph182111664] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022]
Abstract
Smoking cessation interventions are effective, but they are not easily accessible for all treatment-seeking smokers. Mobile health (mHealth) apps have been used in recent years to overcome some of these limitations. Smoking cessation apps can be used in combination with a face-to-face intervention (FFSC-Apps), or alone as general apps (GSC-Apps). The aims of this review were (1) to examine the effects of FFSC-Apps and GSC-Apps on abstinence, tobacco use, and relapse rates; and (2) to describe their features. A systematic review was conducted following the internationally Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of the total 6016 studies screened, 24 were included, of which nine used GSC-Apps and 15 FFSC-Apps. Eight studies reported significant differences between conditions in smoking cessation outcomes, with three of them being in favor of the use of apps, and two between different point-assessments. Concerning Apps features, most GSC-Apps included self-tracking and setting a quit plan, whereas most of the FFSC-Apps included self-tracking and carbon monoxide (CO) measures. Smartphone apps for smoking cessation could be promising tools. However, more research with an adequate methodological quality is needed to determine its effect. Nevertheless, smartphone apps' high availability and attractiveness represent a great opportunity to reach large populations.
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Affiliation(s)
- María Barroso-Hurtado
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (D.S.-C.); (C.M.-V.); (E.B.); (A.L.-D.)
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Daniel Suárez-Castro
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (D.S.-C.); (C.M.-V.); (E.B.); (A.L.-D.)
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Carmela Martínez-Vispo
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (D.S.-C.); (C.M.-V.); (E.B.); (A.L.-D.)
| | - Elisardo Becoña
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (D.S.-C.); (C.M.-V.); (E.B.); (A.L.-D.)
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Ana López-Durán
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (D.S.-C.); (C.M.-V.); (E.B.); (A.L.-D.)
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Escañuela Sánchez T, Matvienko-Sikar K, Linehan L, O'Donoghue K, Byrne M, Meaney S. Facilitators and barriers to substance-free pregnancies in high-income countries: A meta-synthesis of qualitative research. Women Birth 2021; 35:e99-e110. [PMID: 33935004 DOI: 10.1016/j.wombi.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/12/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have associated substance use (alcohol, illicit drugs and smoking) to negative pregnancy outcomes, including higher risk of stillbirth. AIM This study aims to identify facilitators and barriers reported by women to remain substance free during pregnancy. METHODS A systematic search was conducted in six databases from inception to March 2019 and updated in November 2020. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women's experiences of substance use during pregnancy were eligible. Meta-ethnography was used to facilitate this meta-synthesis. FINDINGS Twenty-two studies were included for analysis. Internal barriers included the perceived emotional and social benefits of using substances such as stress coping, and the associated feelings of shame and guilt. Finding insensitive professionals, the lack of information and discussion about risks, and lack of social support were identified as external barriers. Furthermore, the social stigma and fear of prosecution associated with substance use led some women to conceal their use. Facilitators included awareness of the health risks of substance use, having intrinsic incentives and finding support in family, friends and professionals. DISCUSSION Perceived benefits, knowledge, experiences in health care settings, and social factors all play important roles in women's behaviours. These factors can co-occur and must be considered together to be able to understand the complexity of prenatal substance use. CONCLUSION Increased clinical and community awareness of the modifiable risk factors associated with substance use during pregnancy presented in this study, is necessary to inform future prevention efforts.
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland.
| | | | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland.
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland.
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, National University of Ireland, Ireland.
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork.
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McDaid L, Thomson R, Emery J, Coleman T, Cooper S, Phillips L, Naughton F. Agreement and Disparities between Women and Stop-Smoking Specialists about How to Promote Adherence to Nicotine Replacement Therapy in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094673. [PMID: 33924763 PMCID: PMC8125676 DOI: 10.3390/ijerph18094673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
Evidence for the effectiveness of nicotine replacement therapy (NRT) for smoking-cessation in pregnancy is weak. This has been attributed to insufficient dosing and low adherence. This study investigated the acceptability of key messages and delivery modes for a behavioral intervention to increase NRT adherence in pregnancy. Semi-structured telephone interviews were carried out with pregnant or postpartum women aged ≥16 from across England, who had been offered NRT during pregnancy as part of a quit attempt and who struggled to quit (n = 10), and a focus group with stop-smoking specialists from across England (n = 6). The two data sources were coded separately using a thematic approach and then integrated to compare perspectives. Women and specialists agreed on message tone and delivery modes. However, views diverged on the most influential sources for certain messages and whether some information should be given proactively or reactively. There was also disagreement over which messages were novel and which were routinely delivered. This study demonstrates the value of capturing and integrating different perspectives and informational requirements when developing behavior-change interventions. The findings provide useful insights for designing a pregnancy-specific NRT adherence intervention that is acceptable to both those who will deliver and receive it.
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Affiliation(s)
- Lisa McDaid
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
- Correspondence:
| | - Ross Thomson
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Joanne Emery
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Lucy Phillips
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Felix Naughton
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
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Herbec A, Shahab L, Brown J, Ubhi HK, Beard E, Matei A, West R. Does addition of craving management tools in a stop smoking app improve quit rates among adult smokers? Results from BupaQuit pragmatic pilot randomised controlled trial. Digit Health 2021; 7:20552076211058935. [PMID: 34868620 PMCID: PMC8637712 DOI: 10.1177/20552076211058935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Delivery of craving management tools via smartphone applications (apps) may improve smoking cessation rates, but research on such programmes remains limited, especially in real-world settings. This study evaluated the effectiveness of adding craving management tools in a cessation app (BupaQuit). METHODS The study was a two-arm pragmatic pilot parallel randomised controlled trial, comparing a fully-automated BupaQuit app with craving management tool with a control app version without craving management tool. A total of 425 adult UK-based daily smokers were enrolled through open online recruitment (February 2015-March 2016), with no researcher involvement, and individually randomised within the app to the intervention (n = 208) or control (n = 217). The primary outcome was self-reported 14-day continuous abstinence assessed at 4-week follow-up. Secondary outcomes included 6-month point-prevalence and sustained abstinence, and app usage. The primary outcome was assessed with Fisher's exact test using intent to treat with those lost to follow-up counted as smoking. Participants were not reimbursed. RESULTS Re-contact rates were 50.4% at 4 weeks and 40.2% at 6 months. There was no significant difference between intervention and control arms on the primary outcome (13.5% vs 15.7%; p = 0.58; relative risk = 0.86, 95% confidence interval = 0.54-1.36) or secondary cessation outcomes (6-month point prevalence: 14.4% vs 17.1%, p = 0.51; relative risk = 0.85, 95% confidence interval = 0.54-1.32; 6-month sustained: 11.1% vs 13.4%, p = 0.55; relative risk = 0.83, 95% confidence interval = 0.50-1.38). Bayes factors supported the null hypothesis (B[0, 0, 1.0986] = 0.20). Usage was similar across the conditions (mean/median logins: 9.6/4 vs 10.5/5; time spent: 401.8/202 s vs 325.8/209 s). CONCLUSIONS The addition of craving management tools did not affect cessation, and the limited engagement with the app may have contributed to this.
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Affiliation(s)
- Aleksandra Herbec
- Department of Behavioural Science and Health, University College London, UK
- Department of Clinical, Educational and Health Psychology, UCL
Centre for Behaviour Change, University College London, UK
- UCL Tobacco and Alcohol Research Group (UTARG), University College London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, UK
- UCL Tobacco and Alcohol Research Group (UTARG), University College London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK
- UCL Tobacco and Alcohol Research Group (UTARG), University College London, UK
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Harveen Kaur Ubhi
- Department of Behavioural Science and Health, University College London, UK
- UCL Tobacco and Alcohol Research Group (UTARG), University College London, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, UK
- UCL Tobacco and Alcohol Research Group (UTARG), University College London, UK
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Alexandru Matei
- Bupa Centre Medical, UK
- Department of Computer Science, University College London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, UK
- UCL Tobacco and Alcohol Research Group (UTARG), University College London, UK
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Campbell K, Coleman-Haynes T, Bowker K, Cooper SE, Connelly S, Coleman T. Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 5:CD013629. [PMID: 32441810 PMCID: PMC7387757 DOI: 10.1002/14651858.cd013629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) delivers nicotine without the toxic chemicals present in tobacco smoke. It is an effective smoking cessation aid in non-pregnant smokers, but there is less evidence of effectiveness in pregnancy. Systematic review evidence suggests that pregnant women do not adhere to NRT as prescribed, which might undermine effectiveness. Electronic cigarettes (e-cigarettes) have grown in popularity, but effectiveness and safety in pregnancy are not yet established. The determinants of uptake and use of NRT and e-cigarettes in pregnancy are unknown. OBJECTIVES To explore factors affecting uptake and use of NRT and e-cigarettes in pregnancy. SEARCH METHODS We searched MEDLINE(R), CINAHL and PsycINFO on 1 February 2019. We manually searched OpenGrey database and screened references of included studies and relevant reviews. We also conducted forward citation searches of included studies. SELECTION CRITERIA We selected studies that used qualitative methods of data collection and analysis, included women who had smoked in pregnancy, and elicited participants' views about using NRT/e-cigarettes for smoking cessation or harm reduction (i.e. to smoke fewer cigarettes) during pregnancy. DATA COLLECTION AND ANALYSIS We identified determinants of uptake and use of NRT/e-cigarettes in pregnancy using a thematic synthesis approach. Two review authors assessed the quality of included studies with the Wallace tool. Two review authors used the CERQual approach to assess confidence in review findings. The contexts of studies from this review and the relevant Cochrane effectiveness review were not similar enough to fully integrate findings; however, we created a matrix to juxtapose findings from this review with the descriptions of behavioural support from trials in the effectiveness review. MAIN RESULTS We included 21 studies: 15 focused on NRT, 3 on e-cigarettes, and 3 on both. Studies took place in five high-income countries. Most studies contributed few relevant data; substantially fewer data were available on determinants of e-cigarettes. Many studies focused predominantly on issues relating to smoking cessation, and determinants of NRT/e-cigarette use was often presented as one of the themes. We identified six descriptive themes and 18 findings within those themes; from these we developed three overarching analytical themes representing key determinants of uptake and adherence to NRT and/or e-cigarettes in pregnancy. The analytical themes show that women's desire to protect their unborn babies from harm is one of the main reasons they use these products. Furthermore, women consider advice from health professionals when deciding whether to use NRT or e-cigarettes; when health professionals tell women that NRT or e-cigarettes are safer than smoking and that it is okay for them to use these in pregnancy, women report feeling more confident about using them. Conversely, women who are told that NRT or e-cigarettes are as dangerous or more dangerous than smoking and that they should not use them during pregnancy feel less confident about using them. Women's past experiences with NRT can also affect their willingness to use NRT in pregnancy; women who feel that NRT had worked for them (or someone they know) in the past were more confident about using it again. However, women who had negative experiences were more reluctant to use NRT. No trials on e-cigarette use in pregnancy were included in the Cochrane effectiveness review, so we considered only NRT findings when integrating results from this review and the effectiveness review. No qualitative studies were conducted alongside trials, making full integration of the findings challenging. Women enrolled in trials would have agreed to being allocated to NRT or control group and would have received standardised information on NRT at the start of the trial. Overall, the findings of this synthesis are less relevant to women's decisions about starting NRT in trials and more likely to help explain trial participants' adherence to NRT after starting it. We considered most findings to be of moderate certainty; we assessed findings on NRT use as being of higher certainty than those on e-cigarette use. This was mainly due to the limited data from fewer studies (only in the UK and USA) that contributed to e-cigarette findings. Overall, we judged studies to be of acceptable quality with only minor methodological issues. AUTHORS' CONCLUSIONS Consistent messages from health professionals, based on high-quality evidence and clearly explaining the safety of NRT and e-cigarettes compared to smoking in pregnancy, could help women use NRT and e-cigarettes more consistently/as recommended. This may improve their attitudes towards NRT or e-cigarettes, increase their willingness to use these in their attempt to quit, and subsequently encourage them to stay smoke-free.
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Affiliation(s)
| | | | - Katharine Bowker
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sue E Cooper
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sarah Connelly
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Ames HMR, Glenton C, Lewin S, Tamrat T, Akama E, Leon N. Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 10:CD013447. [PMID: 31608981 PMCID: PMC6791116 DOI: 10.1002/14651858.cd013447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support. OBJECTIVES To explore clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH). SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-Process & Other Non-Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3-6 July 2017 dependant on the database (See appendix 2). SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis; that explored clinets' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, employing a three-step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness. MAIN RESULTS We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low- and middle-income settings and sixteen in high-income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.Our synthesis showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme (moderate confidence).For an overview of the findings and our confidence in the evidence, please see the 'Summary of qualitative findings' tables.Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue. AUTHORS' CONCLUSIONS Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Claire Glenton
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Simon Lewin
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
| | - Tigest Tamrat
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerlandCH‐1211
| | - Eliud Akama
- University of WashingtonSeattleWashingtonUSA
| | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
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Herbec A, Brown J, Shahab L, West R, Raupach T. Pragmatic randomised trial of a smartphone app (NRT2Quit) to improve effectiveness of nicotine replacement therapy in a quit attempt by improving medication adherence: results of a prematurely terminated study. Trials 2019; 20:547. [PMID: 31477166 PMCID: PMC6720069 DOI: 10.1186/s13063-019-3645-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/09/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) bought over the counter (OTC) appears to be largely ineffective for smoking cessation, which may be partially explained by poor adherence. We developed and evaluated the NRT2Quit smartphone app (for iOS) designed to improve quit attempts with OTC NRT by improving adherence to the medications. METHODS This study was a pragmatic double-blind randomised controlled trial with remote recruitment through leaflets distributed to over 300 UK-based community pharmacies. The study recruited adult daily smokers (≥10 cigarettes per day) who bought NRT, wanted to quit smoking, downloaded NTR2Quit and completed the registration process within the app. Participants were automatically randomly assigned within the app to the intervention (full) version of NRT2Quit or to its control (minimal) versions. The primary outcome was biochemically verified 4-week abstinence assessed at 8-week follow-up using Russell Standard criteria and intention to treat. Bayes factors were calculated for the cessation outcome. Secondary outcomes were self-reported abstinence, NRT use, app use and satisfaction with the app. RESULTS The study under-recruited. Only 41 participants (3.5% of the target sample) were randomly assigned to NRT2Quit (n = 16) or the control (n = 25) app versions between March 2015 and September 2016. The follow-up rate was 51.2%. The intervention participants had numerically higher biochemically verified quit rates (25.0% versus 8.0%, P = 0.19, odds ratio = 3.83, 0.61-24.02). The calculated Bayes factor, 1.92, showed that the data were insensitive to test for the hypothesis that the intervention app version aided cessation. The intervention participants had higher median logins (2.5 versus 0, P = 0.01) and were more likely to use NRT at follow-up (100.0% versus 28.6%, P = 0.03) and recommend NRT2Quit to others (100.0% versus 28.6%, P = 0.01). CONCLUSIONS Despite very low recruitment, there was preliminary but inconclusive evidence that NRT2Quit may improve short-term abstinence and adherence among smokers using NRT. Well-powered studies on NRT2Quit are needed, but different recruitment methods will be required to engage smokers through community pharmacies or other channels. TRIAL REGISTRATION ISRCTN ISRCTN33423896 , prospectively registered on 22 March 2015.
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Affiliation(s)
- Aleksandra Herbec
- Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
- Centre for Behaviour Change, University College London, Room 353, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Jamie Brown
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Lion Shahab
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Robert West
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Tobias Raupach
- Centre for Behaviour Change, University College London, Room 353, 1-19 Torrington Place, London, WC1E 6BT UK
- National Centre for Smoking Cessation and Training, 1 Great Western Industrial Centre, Dorchester, DT1 1RD UK
- Clinic for Cardiology and Pneumology, University Medical Centre, Universitaetsmedizin Goettingen UBFT, Robert-Koch, Strasse 40, 37075 Goettingen, Germany
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Fergie L, Coleman T, Ussher M, Cooper S, Campbell KA. Pregnant Smokers' Experiences and Opinions of Techniques Aimed to Address Barriers and Facilitators to Smoking Cessation: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2772. [PMID: 31382531 PMCID: PMC6695602 DOI: 10.3390/ijerph16152772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 01/02/2023]
Abstract
Pregnant women experience certain barriers and facilitators (B&Fs) when trying to quit smoking. This study aimed to elicit women's views on techniques that could help overcome or enhance these. Semi-structured interviews were conducted with 12 pregnant women who had experience of smoking during pregnancy. Participants were prompted to discuss experiences of B&Fs and give suggestions of techniques that could address these appropriately. A thematic analysis was conducted using the one sheet of paper method. Four themes relating to suggested techniques were identified: accessing professional help, nicotine replacement therapy (NRT), distraction, and social interactions. Experiences of accessing professional help were generally positive, especially if there was a good rapport with, and easy access to a practitioner. Most women were aware of NRT, those who had used it reported both negative and positive experiences. Praise and encouragement from others towards cessation attempts appeared motivating; peer support groups were deemed useful. Women reported experiencing B&Fs which fell under four themes: influence of others, internal motivation, cues to smoke, and health. Overall, accessing professional support generated positive changes in smoking habits. Establishing ways of how to encourage more women to seek help and raising awareness of different types of support available would seem beneficial.
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Affiliation(s)
- Libby Fergie
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London SW17 0RE, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Katarzyna A Campbell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Diamanti A, Papadakis S, Schoretsaniti S, Rovina N, Vivilaki V, Gratziou C, Katsaounou PA. Smoking cessation in pregnancy: An update for maternity care practitioners. Tob Induc Dis 2019; 17:57. [PMID: 31582946 PMCID: PMC6770622 DOI: 10.18332/tid/109906] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/10/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings. METHODS We conducted a qualitative review of published peer reviewed and grey literature. RESULTS There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high. CONCLUSIONS There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.
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Affiliation(s)
- Athina Diamanti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sotiria Schoretsaniti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Rovina
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Respiratory Medicine, ‘Sotiria’ Chest Disease Hospital, Athens, Greece
| | | | - Christina Gratziou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Evgenidio Hospital, Athens, Greece
| | - Paraskevi A. Katsaounou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- First ICU, Evangelismos Hospital, Athens, Greece
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Herbec A, Tombor I, Shahab L, West R. "If I'd Known …"-a Theory-Informed Systematic Analysis of Missed Opportunities in Optimising Use of Nicotine Replacement Therapy and Accessing Relevant Support: a Qualitative Study. Int J Behav Med 2018; 25:579-591. [PMID: 30062656 PMCID: PMC6182503 DOI: 10.1007/s12529-018-9735-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose Nicotine replacement therapy (NRT) is often used suboptimally by smokers. Previous research has focused on cognitions and attitudes as potential reasons. This study drew on theoretical frameworks of behaviour to comprehensively explore smokers’ NRT use to identify new intervention targets. Methods Semi-structured face-to-face interviews were conducted with 16 adult UK-based smokers and ex-smokers who used NRT in recent quit attempts (mean (SD) age = 34.9(10.3); 82.3% women). The COM-B (capability, opportunity, motivation, behaviour) model and the theoretical domains framework informed the interviews and analyses. Data were analysed in NVivo 11. Results Two related behaviours were identified relevant to NRT use: use of NRT per se and engaging with information and support with NRT use. A meta-theme of “missed opportunity” identified instances when smokers did not or could not engage in these behaviours. For use of NRT per se, these included limited knowledge, poor technique of use, low motivation to optimise use, and lack of role models. For engaging with information and support, they included low awareness of optimal use techniques, selective information-seeking, low expectations, limited exposure to guidelines, deficient advice from healthcare professionals, and suboptimal product display. Prior suboptimal experience tended to negatively affect subsequent use and views. Participants were interested in accessible and comprehensive guidelines on NRT and its use. Conclusions There appear to be important missed opportunities for optimal use of NRT both in terms of use itself and engagement with information on optimal use. These missed opportunities arise from a range of capability, motivational, and opportunity-related factors. Electronic supplementary material The online version of this article (10.1007/s12529-018-9735-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aleksandra Herbec
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Ildiko Tombor
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
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Bauer IE, Kiropoulos LA, Crist NP, Hamilton JE, Soares JC, Meyer TD. A qualitative study investigating bipolar patients' expectations of a lifestyle intervention: A self-management program. Arch Psychiatr Nurs 2018; 32:555-560. [PMID: 30029747 DOI: 10.1016/j.apnu.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/17/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is some evidence supporting the efficacy of lifestyle interventions in changing unhealthy habits and reduce the risk of developing comorbid conditions in Bipolar Disorder (BD). AIMS This qualitative study aimed to identify what an optimal lifestyle intervention would look like for individuals with BD. METHODS The current findings are based on one focus group and two paired interviews including a total of 10 individuals with BD (44.20 ± 11.11 years; 6 females). Groups' transcripts were analyzed using a narrative approach. Primary themes included facilitating factors and barriers, general content, outcomes, format of the intervention, and background factors. RESULTS Participants were in favor of a group-based lifestyle intervention as part of their usual treatment. The optimal group format would include 4 to 10 individuals, and comprise of 12 to 18 sessions lasting 1 to 1.5 h each. Accountability, motivation, interaction, and group activities were identified as contributing to the success of a lifestyle intervention. CONCLUSIONS This qualitative study provides important information regarding aspects of lifestyle intervention format and delivery for individuals with BD. We identified barriers and facilitating factors that should be addressed in health promotion interventions delivered within community mental health settings.
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Affiliation(s)
- Isabelle E Bauer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
| | - Litza A Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Nicholas P Crist
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Herbeć A, Perski O, Shahab L, West R. Smokers' Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E288. [PMID: 29414907 PMCID: PMC5858357 DOI: 10.3390/ijerph15020288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 12/29/2022]
Abstract
Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or "CO Smartphone Systems" (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, semi-structured interviews explored participants' expectations of CSSs. Secondly, a think-aloud study identified participants' reactions to a personal CO monitor and to existing or prototype apps. Framework Analysis identified five themes: (1) General views, needs, and motivation to use CSSs; (2) Views on the personal CO monitor; (3) Practicalities of CSS use; (4) Desired features in associated apps; and (5) Factors affecting preferences for CSSs and their use. Participants had high expectations of CSSs and their potential to increase motivation. Priority app features included: easy CO testing journeys, relevant and motivating feedback, and recording of contextual data. Appearance and usability of the personal CO monitor, and accuracy and relevance of CO testing were considered important for engagement. Participants differed in their motivation to use and preferences for CSSs features and use, which might have non-trivial impact on evaluation efforts. Personal CO monitors and associated apps may be attractive tools for smokers, but making CSSs easy to use and evaluating these among different groups of smokers may be challenging.
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Affiliation(s)
- Aleksandra Herbeć
- Research Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK.
| | - Olga Perski
- Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, UK.
| | - Lion Shahab
- Research Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK.
| | - Robert West
- Research Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK.
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Tombor I, Shahab L, Brown J, Crane D, Michie S, West R. Development of SmokeFree Baby: a smoking cessation smartphone app for pregnant smokers. Transl Behav Med 2017; 6:533-545. [PMID: 27699682 PMCID: PMC5110502 DOI: 10.1007/s13142-016-0438-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pregnant smokers may benefit from digital smoking cessation interventions, but few have been designed for this population. The aim was to transparently report the development of a smartphone app designed to aid smoking cessation during pregnancy. The development of a smartphone app (‘SmokeFree Baby’) to help pregnant women stop smoking was guided by frameworks for developing complex interventions, including the Medical Research Council (MRC), Multiphase Optimization Strategy (MOST) and Behaviour Change Wheel (BCW). Two integrative behaviour change theories provided the theoretical base. Evidence from the scientific literature and behaviour change techniques (BCTs) from the BCT Taxonomy v1 informed the intervention content. The app was developed around five core modules, each with a distinct intervention target (identity change, stress management, health information, promoting use of face-to-face support and behavioural substitution) and available in a ‘control’ or ‘full’ version. SmokeFree Baby has been developed as part of a multiphase intervention optimization to identify the optimum combination of intervention components to include in smartphone apps to help pregnant smokers stop smoking.
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Affiliation(s)
- Ildiko Tombor
- Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BT, London, UK.
| | - Lion Shahab
- Department of Epidemiology and Public Health, University College London, WC1E 6BT, London, UK
| | - Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BT, London, UK
| | - David Crane
- Department of Clinical, Educational and Health Psychology, University College London, WC1E 6BT, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, WC1E 6BT, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BT, London, UK
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Sloan M, Hopewell S, Coleman T, Cooper S, Naughton F. Smoking Cessation Support by Text Message During Pregnancy: A Qualitative Study of Views and Experiences of the MiQuit Intervention. Nicotine Tob Res 2017; 19:572-577. [PMID: 28403457 PMCID: PMC5896448 DOI: 10.1093/ntr/ntw241] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022]
Abstract
Introduction: SMS text messaging is increasingly used for delivering smoking cessation support and pilot studies suggest this may also be useful in pregnancy. This study explores the views of women who received a tailored text messaging cessation intervention (MiQuit) during pregnancy, focusing on acceptability, perceived impact, and suggestions for improvements. Methods: Semi-structured interviews were undertaken with 15 purposively sampled women who had received the MiQuit intervention during pregnancy as part of a randomized controlled trial. Data were analyzed thematically. Results: Three main themes were identified: “impact”, “approach,” and “optimization.” Participants described an immediate, yet often short-lived, impact from the texts that distracted and delayed them from smoking and they perceived that texts focusing on the development of and risk to the baby generated more enduring emotional impacts. Most women found receiving support by text preferable to face-to-face cessation support, with participants citing the greater regularity, convenience, and non-judgmental style as particular advantages. Participants would have preferred a longer support program with increased tailoring, greater customization of text timings and consideration of cutting down as an alternative/precursor to quitting. Conclusion: Pregnancy-specific cessation support by text message was well received and participants considered the support increased their motivation to stop smoking. The focus on the developing baby, the regularity of contact and the provision of gentle, encouraging messages were highlighted as particularly important elements of the program. Implications: This study adds further evidence to the acceptability and perceived positive impact of text-messaging programs in aiding smoking cessation in pregnancy. The findings indicate that for some women, this type of support is preferable to face-to-face methods and could be utilized by health professionals, either in addition to current methods or as an alternative. This study is also relevant to researchers developing health-related text programs to consider participants’ desire for greater tailoring. Further research is required into adapting and continuing text support for women postpartum.
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Affiliation(s)
- Melanie Sloan
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Sarah Hopewell
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Naughton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
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Wu J, Tombor I, Shahab L, West R. Usability testing of a smoking cessation smartphone application ('SmokeFree Baby'): A think-aloud study with pregnant smokers. Digit Health 2017; 3:2055207617704273. [PMID: 29942594 PMCID: PMC6001180 DOI: 10.1177/2055207617704273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/10/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Only a few digital interventions have been developed for pregnant smokers, and little is known about the acceptability and usability of smartphone apps to aid cessation in pregnancy. This study aimed to explore pregnant smokers' views on the design, content and usability of a pregnancy-specific smoking cessation app in order to inform intervention development and optimisation. METHODS Ten interviews were conducted and the 'think-aloud' protocol was used in order to explore participants' views about a smoking cessation smartphone app ('SmokeFree Baby'). The data were subsequently thematically analysed. Participants were 18 and over, pregnant, and daily or weekly cigarette smokers. RESULTS Three main themes were identified: views about the design elements, mode of delivery and content of the intervention. App design was considered as an important element that might influence potential users' engagement with the intervention. Participants felt that the intervention content was educational, motivational and non-judgemental. However, it was emphasised that the app should provide further options for personalisation and include more practical features. CONCLUSIONS Delivering smoking cessation support via a smartphone app can be feasible and acceptable for pregnant smokers. They appear to value content that is motivational, educational and personalised, and meeting these requirements may be important for user experience and promoting engagement with the intervention.
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Affiliation(s)
- Joyce Wu
- Department of Behavioural Science and Health,
University College London, UK
| | - Ildiko Tombor
- Department of Behavioural Science and Health,
University College London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health,
University College London, UK
| | - Robert West
- Department of Behavioural Science and Health,
University College London, UK
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Stiegler A, Abele H, Batra A. IRIS - An Internet Based Intervention as a Suitable Path to Addictive Substance Use Prevention and Counselling in Pregnancy? Beneficiary Profiles and User Satisfaction. Geburtshilfe Frauenheilkd 2016; 76:1163-1171. [PMID: 27904166 DOI: 10.1055/s-0042-109867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Alcohol or tobacco consumption in pregnancy can harm the unborn child. Counselling on this subject is therefore of major importance. The aim of the presented study was not only to develop an internet based, professionally e-mail accompanied platform for alcohol or tobacco consuming pregnant women ("IRIS Platform") but also to analyse the beneficiary profiles and investigate the practicability and acceptance of the platform among women and referring gynaecologists. The offer comprised three 12-week counselling programmes (alcohol, tobacco, combined consumption). Altogether 32 women registered within the recruitment period of 20 weeks, only 9 of them at the suggestion of gynaecologists. Thirty were enrolled. The average age was 31 years. Ten women were pregnant for the first time, 14 unplanned. Most of them were smokers (n = 29). 75 % (n = 12 of 16) of them had smoked in the previous pregnancies, 5 of 16 women had suffered miscarriages. Six women completed the entire 12 week programme. The abstinence rate after 3 months was min. 18.5 % (ITT) in the tobacco group, while in the alcohol programme 3 women achieved abstinence. Satisfaction was reported especially for the eCoach initiative. The results demonstrate that an internet-based service like IRIS can be a useful form of support for tobacco or alcohol consuming pregnant women. A particular challenge is the accessibility of the persons concerned and the form in which alcohol consuming pregnant women are approached in daily medical practice. The individual contact to the eCoach can be a decisive form of support and aid to motivation.
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Affiliation(s)
- A Stiegler
- Section for Addiction Medicine and Addiction Research, University Hospital Tübingen, University Department of Psychiatry and Psychotherapy, Tübingen, Germany
| | - H Abele
- University Gynaecology Department, University Hospital Tübingen, Tübingen, Germany
| | - A Batra
- Section for Addiction Medicine and Addiction Research, University Hospital Tübingen, University Department of Psychiatry and Psychotherapy, Tübingen, Germany
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Powell J, Newhouse N, Martin A, Jawad S, Yu LM, Davoudianfar M, Locock L, Ziebland S. A novel experience-based internet intervention for smoking cessation: feasibility randomised controlled trial. BMC Public Health 2016; 16:1156. [PMID: 27835953 PMCID: PMC5106834 DOI: 10.1186/s12889-016-3821-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/04/2016] [Indexed: 12/04/2022] Open
Abstract
Background The internet is frequently used to share experiences of health and illness, but this phenomenon has not been harnessed as an intervention to achieve health behaviour change. The aim of this study was to determine the feasibility of a randomised trial assessing the effects of a novel, experience-based website as a smoking cessation intervention. The secondary aim was to measure the potential impact on smoking behaviour of both the intervention and a comparator website. Methods A feasibility randomised controlled single-blind trial assessed a novel, experience-based website containing personal accounts of quitting smoking as a cessation intervention, and a comparator website providing factual information. Feasibility measures including recruitment, and usage of the interventions were recorded, and the following participant-reported outcomes were also measured: Smoking Abstinence Self-Efficacy Questionnaire, the single-item Motivation to Stop Scale, self-reported abstinence, quit attempts and health status outcomes. Eligible smokers from two English regions were entered into the trial and given access to their allocated website for two weeks. Results Eighty-seven smokers were randomised, 65 completed follow-up (75 %). Median usage was 15 min for the intervention, and 5 min for the comparator (range 0.5–213 min). Median logins for both sites was 2 (range 1–20). All participant-reported outcomes were similar between groups. Conclusions It was technically feasible to deliver a novel intervention harnessing the online sharing of personal experiences as a tool for smoking cessation, but recruitment was slow and actual use was relatively low, with attrition from the trial. Future work needs to maximize engagement and to understand how best to assess the value of such interventions in everyday use, rather than as an isolated ‘dose of information’. Trial registration ISRCTN29549695 DOI 10.1186/ISRCTN29549695. Registered 17/05/2013.
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Affiliation(s)
- John Powell
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Nikki Newhouse
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Angela Martin
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sena Jawad
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mina Davoudianfar
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Berlin I, Singleton EG, Heishman SJ. Craving and Withdrawal Symptoms During Smoking Cessation: Comparison of Pregnant and Non-Pregnant Smokers. J Subst Abuse Treat 2016; 63:18-24. [PMID: 26806411 DOI: 10.1016/j.jsat.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
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Trujillo Gómez JM, Díaz-Gete L, Martín-Cantera C, Fábregas Escurriola M, Lozano Moreno M, Burón Leandro R, Gomez Quintero AM, Ballve JL, Clemente Jiménez ML, Puigdomènech Puig E, Casas More R, Garcia Rueda B, Casajuana M, Méndez-Aguirre M, Garcia Bonias D, Fernández Maestre S, Sánchez Fondevila J. Intervention for Smokers through New Communication Technologies: What Perceptions Do Patients and Healthcare Professionals Have? A Qualitative Study. PLoS One 2015; 10:e0137415. [PMID: 26340346 PMCID: PMC4560416 DOI: 10.1371/journal.pone.0137415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022] Open
Abstract
Background The use of information and communication technologies (ICTs) in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking. Objectives To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose. Methods A qualitative, descriptive–interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer’s notes. Data were analyzed with the ATLAS TI 6.0 programme. Results Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers. Conclusions Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not substitute personal contact in the smoking cessation programme.
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Affiliation(s)
- Jose Manuel Trujillo Gómez
- Centro de Salud Cuevas del Almanzora, Servicio Andaluz de Salud, Almería, Spain
- Primary Healthcare University Research Institute IDIAP Jordi Gol, Barcelona, Spain
- * E-mail:
| | - Laura Díaz-Gete
- Centre d’Atenció Primaria La Sagrera, Institut Català de la Salut, Barcelona, Spain
| | - Carlos Martín-Cantera
- Primary Healthcare University Research Institute IDIAP Jordi Gol, Barcelona, Spain
- Centre d’Atenció Primaria Passeig de Sant Joan, Institut Català de la Salut, Barcelona, Spain
| | | | - Maribel Lozano Moreno
- Centre d’Atenció Primaria Passeig de Sant Joan, Institut Català de la Salut, Barcelona, Spain
| | | | | | - Jose Luis Ballve
- Centre d’Atenció Primària Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, Spain
| | | | | | - Ramón Casas More
- Centre d’Atenció Primaria Sant Antoni, Institut Català de la Salut, Barcelona, Spain
| | - Beatriz Garcia Rueda
- Centre d’Atenció Primaria Goretti Badia, Institut Català de la Salut, Barcelona, Spain
| | - Marc Casajuana
- Primary Healthcare University Research Institute IDIAP Jordi Gol, Barcelona, Spain
| | - Marga Méndez-Aguirre
- Centre d’Atenció Primaria Vallcarca-Sant Gervasi, Institut Català de la Salut, Barcelona, Spain
| | - David Garcia Bonias
- Centre d’Atenció Primaria Vallcarca-Sant Gervasi, Institut Català de la Salut, Barcelona, Spain
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