Smoking cessation in pregnancy: a call to action.London: Royal College of Physicians; 2013

Ajzen I. The theory of planned behaviour. Organ Behav Hum Decis Process. 1991; 50:179-211

Aveyard P, Begh R, Parsons A, West R. Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 2012; 107:(6)1066-73

Banderali G, Martelli A, Landi M, Moretti F, Betti F, Radaelli G, Lassandro C, Verduci E. Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review. J Transl Med. 2015; 13

Brose LS, West R, Michie S, Kenyon JAM, McEwan A. Effectiveness of an online knowledge training and assessment program for stop smoking practitioners. Nicotine Tob Res. 2012; 14:(7)794-800

Chamberlain C, O'Mara-Eves A, Porter J Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2013; (10)

Compassion in Practice: Nursing, Midwifery and Care Staff: Our Vision.London: NHS England; 2012

London: Department of Health; 2010

Choi W-Y, Kim C-H, Lee O-G. Effects of brief smoking cessation education with expiratory carbon monoxide measurement on level of motivation to quit smoking. Korean J Fam Med. 2013; 34:(3)190-8

Dawson A, Verweij M. Public health: beyond the role of the state. Public Health Ethics. 2015; 8:(1)1-3

De Wilde K, Tency I, Steckel S, Temmerman M, Boudrez H, Maes L. Which role do midwives and gynecologists have in smoking cessation in pregnant women? – A study in Flanders, Belgium. Sex Reprod Healthc. 2015; 6:(2)66-73

Improving Outcomes and Supporting Transparency Part 1A: A Public Health Outcomes Framework for England, 2013-2016.London: Department of Health; 2013

The Midwifery Public Health Contribution.London: DH; 2013

Edvardsson K, Ivarsson A, Eurenius E Giving offspring a health start: Parents experiences of health promotion and lifestyle change during pregnancy and early parenthood. BMC Public Health. 2011; 11

Edwins J. Supporting smoking cessation in pregnancy. British Journal of Midwifery. 2013; 21:(3)174-8

Efraimsson EO, Fossum B, Ehrenberg A, Larsson K, Klang B. Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics. JAN. 2012; 68:(4)767-782

Egan G. The Skilled Helper: A Problem-Management And Opportunity-Development Approach To Helping, 9th edition. Belmont, CA: Brooks/Cole; 2010

England C, Raynor M. Psychology For Midwives: Pregnancy, Childbirth And Puerperium.London: Open University Press; 2010

Flemming K, Graham H, McCaughan D, Angus K, Bauld L. The barriers and facilitators to smoking cessation experienced by women's partners during pregnancy and the post-partum period: A systematic review of qualitative research. BMC Public Health. 2015; 15

Flemming K, Graham H, McCaughan D, Angus K, Sinclair L, Bauld L. Health professionals' perceptions of the barriers and facilitators to providing women in pregnancy and during the post-partum period: a systematic review of qualitative research. BMC Public Health. 2016; 16

Geraghty S, Lauva M. Keeping the shining roads open: intuition in midwifery practice. Pract Midwife. 2015; 18:(10)42-5

Hayashi K, Matsuda Y, Kawamichi Y, Shiozaki A, Saito S. Smoking during pregnancy increases risks of various obstetric complications: A case-cohort study of the Japan perinatal registry network database. J Epidemiol. 2011; 21:(1)61-6

Hemsing N, Greaves L, O'Leary R, Chan K, Okoli C. Partner support for smoking cessation during pregnancy: a systematic review. Nicotine Tob Res. 2012; 14:(7)767-76

Hertfordshire County Council. Love your bump campaign toolkit. 2015. (accessed 1 February 2017)

Hertfordshire Health and Wellbeing Strategy 2016–2020.Hertfordshire: Health and Wellbeing Board; 2016

Hoppe MH. Active Listening: Improve Your Ability To Listen And Lead.Oxford: Wiley-Blackwell; 2011

The Hague: International Confederation of Midwives. 2011;

Ko TJ, Tsai LY, Chu LC Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: a birth cohort study. Pediatr Neonatol. 2014; 55:(1)20-7

Lawrence W, Black C, Tinati T ‘Making every contact count’: Evaluation of the impact of an intervention to train health and social care practitioners in skills to support health behaviour change. J Health Psychol. 2016; 21:(2)138-51

Lee DJ, Haynes CL, Garrod D. Exploring the midwife's role in health promotion practice. Br J Midwifery. 2012; 20:(3)178-86

Leonardi-Bee J, Jere ML, Britton J. Exposure to parental and sibling smoking and the risk of smoking uptake in childhood and adolescence: a systematic review and meta-analysis. Thorax. 2011; 66:(10)847-55

Statistics on Women's Smoking Status at Time of Delivery: England.London: Health and Social Care Information Centre; 2016

Marcinowicz L, Konstantynowicz J, Godlewski C Patient's perceptions of GP non-verbal communication: a qualitative study. Br J Gen Pract. 2010; 60:(571)83-7

McEwan A, McIlvar M, Locker J. Very brief advice on smoking. Nurs Times. 2012; 108:(9)

McEwan A. Smoking cessation: a briefing for midwifery staff.London: National Centre for Smoking Cessation and Training; 2016

Montaño DE, Kasprzyk D. Theory of reasoned action, theory of planned behaviour, and the integrated behavioural model, 4th edition. In: Glanz K, Rimer BK, Viswanath K San Francisco: Jossey-Bass;

Munafó M, Albery I. Key concepts in health psychology.London: Sage Publications; 2008

Mund M, Louwen F, Klingelhoefer D, Gerber A. Smoking and pregnancy – a review on the first major environmental risk factor of the unborn. Int J Environ Res Public Health. 2013; 10:(12)6485-99

Local stop smoking services: service and delivery guidance 2014.London: National Centre for Smoking Cessation and Training; 2014

NHS Future Forum. NHS Future Forum: Summary Report – Second Phase. 2012. (accessed 1 February 2017)

Smoking: Brief interventions and referrals [PH1].London: NICE; 2006

Antenatal care for uncomplicated pregnancies [CG62].London: NICE; 2016

The Code: professional standards of practice and behaviour for nurses and midwives.London: NMC; 2015

Piddennavar R, Krishnappa P. Preparation and evaluation of information leaflet for tobacco users. J Educ Health Promot. 2015; 4

From Evidence into Action: Opportunities to Protect and Improve the Nation's Health.London: Public Health England; 2014

Ripoll J, Girauta H, Ramos M Clinical trial on the efficacy of exhaled carbon monoxide measurement in smoking cessation in primary health care. BMC Public Health. 2012; 12

Sale J, Neale NM. The nurse's approach and communication: foundations for compassionate care, 4th edn. In: Baillie L Boca Raton: CRC Press;

Salleh S, Laxman K. Examining the effect of external factors and context-dependant beliefs of teachers in the use of ICT in teaching: using and elaborated theory of planned behaviour. J Educ Tech Sys. 2015; 43:(3)289-319

Stead LF, Buitrago D, Preciado N, Sachez G. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2013; (5)

Stickley T. From SOLER to SURETY for effective non-verbal communication. Nurse Educ Pract. 2011; 11:(6)395-8

Upton D, Thirlaway K. Promoting Health Behaviour: A Practical Guide, 2nd edition. Oxford: Routledge; 2014

Barriers to success: smoking cessation conversations

02 August 2017
Volume 25 · Issue 8


Using the structure of Azjen's (1991) health behaviour model, this article examines the experience of promoting smoking cessation in a woman's booking appointment. Smoking cessation is a key contributor to adverse health outcomes, and is a priority for health professionals on a local and national scale. Conversations surrounding smoking cessation in pregnancy are often seen as difficult; midwives are often concerned they may harm the developing midwife-woman bond. The use of non confrontational brief intervention based methods may aid health professionals by creating a positive image of behaviour change. Barriers to the success of the intervention are discussed, including institutional pressures alongside ineffective communication skills, and suggestions for future practice are made. The importance of involving partners or family members in health promotion barriers to aid success is highlighted and demonstrates the wider impact midwives have on public health.

The concept of public health involves national and local health initiatives, health education and the creation of social and physical environments to protect and promote population health (Dawson and Verweij, 2015). Health promotion is an integral part of the midwife's role, not only for the woman, but for her family and the wider community (International Confederation of Midwives, 2011; Nursing and Midwifery Council (NMC), 2015). Despite widely accepted health risks and available support, the use of tobacco products remains a health issue in the UK, and smoking cessation is a key health promotion topic for midwives. The experience of promoting smoking cessation in a woman's booking appointment triggered the author to examine the challenges of encouraging a health behaviour change. The woman and her partner were both smokers, and the author's experience is used in the form of a case study to demonstrate the barriers to success encountered by health professionals. Communication methods are discussed, and Ajzen's theory of planned behaviour (Ajzen, 1991) is used to explore the woman's personal attitude, subjective norms and perceived external barriers, before the woman's likelihood to change is determined. Verbal consent from the woman and her partner was gained, and identifying features of the case have been anonymised in compliance with midwives' professional responsibility to maintain confidentiality (NMC, 2015).

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