What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England

Beenstock, Jane; Sniehotta, Falko F; White, Martin; Bell, Ruth; Milne, Eugene MG; Araujo-Soares, Vera

doi:10.1186/1748-5908-7-36

Cited by 138Smoking Behavior and CessationHealth Policy Implementation ScienceBehavioral Health and Interventions

What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England

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Beenstock, Jane, Sniehotta, Falko F, White, Martin, Bell, Ruth, Milne, Eugene MG, Araujo-Soares, Vera·2012·Implementation Science

DOI 10.1186/1748-5908-7-36PMC PMC3465235

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Abstract

Background: Around 5,000 miscarriages and 300 perinatal deaths per year result from maternal smoking in the United Kingdom. In the northeast of England, 22% of women smoke at delivery compared to 14% nationally. Midwives have designated responsibilities to help pregnant women stop smoking. We aimed to assess perceived implementation difficulties regarding midwives’ roles in smoking cessation in pregnancy. Methods: A self-completed, anonymous survey was sent to all midwives in northeast England (n = 1,358) that explores the theoretical explanations for implementation difficulties of four behaviours recommended in the National Institute for Health and Clinical Excellence (NICE) guidance: (a) asking a pregnant woman about her smoking behaviour, (b) referring to the stop-smoking service, (c) giving advice about smoking behaviour, and (d) using a carbon monoxide monitor. Questions covering Michie et al.’s theoretical domain framework (TDF), describing 11 domains of hypothesised behavioural determinants (i.e., ‘knowledge’, ‘skills’, ‘social/professional role/identity’, ‘beliefs about capabilities’, ‘beliefs about consequences’, ‘motivation and goals’, ‘memory’, ‘attention and decision processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, and ‘self-regulation/action planning’), were used to describe perceived implementation difficulties, predict self-reported implementation behaviours, and explore relationships with demographic and professional variables. Results: The overall response rate was 43% (n = 589). The number of questionnaires analysed was 364, following removal of the delivery-unit midwives, who are not directly involved in providing smoking-cessation services. Participants reported few implementation difficulties, high levels of motivation for all four behaviours and identified smoking-cessation work with their role. Midwives were less certain about the consequences of, and the environmental context and resources available for, engaging in this work relative to other TDF domains. All domains were highly correlated. A principal component analysis showed that a single factor (‘propensity to act’), derived from all domains, explained 66% of variance in theoretical domain measures. The ‘propensity to act’ was predictive of the self-reported behaviour ‘Refer all women who smoke……to NHS Stop Smoking Services’ and mediated the relationship between demographic variables, such as midwives’ main place of work, and behaviour. Conclusions: Our findings advance understanding of what facilitates and inhibits midwives’ guideline implementation behaviours in relation to smoking cessation and will inform the development of current practice and new interventions. Using the TDF as a self-completion questionnaire is innovative, and this study supports previous research that the TDF is an appropriate tool to understand the behaviour of healthcare professionals.

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The TDF has been used in a number of studies.
“The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [35]
The TDF was demonstrated to be useful for the development of qualitative and quantitative measurement tools to assess potential implementation behavior determinants.
“The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [35]
The TDF-based questionnaires were developed to assess determinants of specific implementation behaviors in specific settings.
“Furthermore, the questionnaires were developed to assess determinants of specific implementation behaviors in specific settings (i.e., tobacco use prevention and smoking cessation in dental healthcare [34], smoking cessation in maternal care [35], and different types of patient safety behaviors in hospitals [36])”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [35]
Internal consistency reliability of the TDF-based questionnaires was low or could be improved.
“and internal consistency reliability was low [34] or could be improved [35,36].”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [35]

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Baxter S Blank L Guillaume L Messina J Everson-Hock E Burrows J Systematic review of how to stop smoking in pregnancy and following childbirth. Review 2: Factors aiding delivery of effective interventions 2009 The University of Sheffield School of Health and Related Research

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Implementation
(2014)
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Authors: Beenstock, J., Sniehotta, F. F., White, M., Bell, R., Milne, E. M., & Araujo-Soares, V.
Affiliations: Newcastle University (GB)
Durham University (GB)
Corresponding author: Sniehotta, Falko F
ORCID: Beenstock, Jane
Sniehotta, Falko F
White, Martin
Bell, Ruth
Venue: Implementation Science
Publisher: Springer Science and Business Media LLC
Published: 2012-04-24
Volume: 7
Issue: 1
Pages: 36-36
ISSN: 1748-5908 (ISSN-L)
DOI: 10.1186/1748-5908-7-36
PMC: PMC3465235
OpenAlex: W2062076253
Cited by: 138
References: 19
Citations by year: 2026: 3 · 2025: 7 · 2024: 9 · 2023: 11 · 2022: 17 · 2021: 13 · 2020: 16 · 2019: 9 · 2018: 12 · 2017: 9 · 2016: 6 · 2015: 14 · 2014: 6 · 2013: 4 · 2012: 2
FWCI: 5.57
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: Implementation Science (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders: United Kingdom Clinical Research Collaboration
Cancer Research UK
National Institute for Health and Care Research
British Heart Foundation
Medical Research Council
Economic and Social Research Council (ES/G007470/1)
Topics: Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords: midwives, smoking cessation during pregnancy, implementation barriers, NICE guidelines, smoking cessation referral, carbon monoxide monitoring, guideline implementation, maternal smoking, perinatal outcomes, North East England, NHS Stop Smoking Services, social influence, emotions, self-regulation
MeSH terms: Cross-Sectional Studies, England, Female, Humans, Health Knowledge, Attitudes, Practice, Midwifery, Pregnancy, Prenatal Care, Referral and Consultation, Smoking Cessation, Health Care Surveys, Guideline Adherence, Principal Component Analysis

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What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England

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