Improving Behavioral Support for Smoking Cessation in Pregnancy: What Are the Barriers to Stopping and Which Behavior Change Techniques Can Influence These? Application of Theoretical Domains Framework

Citation

Campbell KA, Fergie L, Coleman-Haynes T, Cooper S, Lorencatto F, Ussher M, Dyas J & Coleman T (2018) Improving Behavioral Support for Smoking Cessation in Pregnancy: What Are the Barriers to Stopping and Which Behavior Change Techniques Can Influence These? Application of Theoretical Domains Framework. International Journal of Environmental Research and Public Health, 15 (2), Art. No.: 359. https://doi.org/10.3390/ijerph15020359

Abstract
Behavioral support interventions are used to help pregnant smokers stop; however, of those tested, few are proven effective. Systematic research developing effective pregnancy-specific behavior change techniques (BCTs) is ongoing. This paper reports contributory work identifying potentially-effective BCTs relative to known important barriers and facilitators (B&Fs) to smoking cessation in pregnancy; to detect priority areas for BCTs development. A Nominal Group Technique with cessation experts (n = 12) elicited an expert consensus on B&Fs most influencing women’s smoking cessation and those most modifiable through behavioral support. Effective cessation interventions in randomized trials from a recent Cochrane review were coded into component BCTs using existing taxonomies. B&Fs were categorized using Theoretical Domains Framework (TDF) domains. Matrices, mapping BCT taxonomies against TDF domains, were consulted to investigate the extent to which BCTs in existing interventions target key B&Fs. Experts ranked ‘smoking a social norm’ and ‘quitting not a priority’ as most important barriers and ‘desire to protect baby’ an important facilitator to quitting. From 14 trials, 23 potentially-effective BCTs were identified (e.g., ‘information about consequences). Most B&Fs fell into ‘Social Influences’, ‘Knowledge’, ‘Emotions’ and ‘Intentions’ TDF domains; few potentially-effective BCTs mapped onto every TDF domain. B&Fs identified by experts as important to cessation, are not sufficiently targeted by BCT’s currently within interventions for smoking cessation in pregnancy.

Keywords
smoking cessation; pregnancy; behavior change techniques; intervention development; Theoretical Domains Framework

Journal
International Journal of Environmental Research and Public Health: Volume 15, Issue 2

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Professor Michael Ussher

Professor of Behavioural Medicine, Institute for Social Marketing