The University of Sydney, University Centre for Rural Health, PO Box 3074, Lismore, NSW, 2480, Australia.
Northern New South Wales Local Health District, Locked Mail Bag 11, Lismore, NSW, 2480, Australia.
BMC Pregnancy Childbirth. 2020 Apr 15;20(1):219. doi: 10.1186/s12884-020-02912-0.
Smoking is the most important preventable cause of adverse pregnancy outcomes, but provision of smoking cessation support (SCS) to pregnant women is poor. We examined the association between midwives' implementation of SCS (5As - Ask, Advise, Assess, Assist, Arrange follow-up) and reported barriers/enablers to implementation.
On-line anonymous survey of midwives providing antenatal care in New South Wales (NSW), Australia, assessing provision of the 5As and barriers/enablers to their implementation, using the Theoretical Domains Framework (TDF). Factor analyses identified constructs underlying the 5As; and barriers/enablers. Multivariate general linear models examined relationships between the barrier/enabler factors and the 5As factors.
Of 750 midwives invited, 150 (20%) participated. Respondents more commonly reported Asking and Assessing than Advising, Assisting, or Arranging follow-up (e.g. 77% always Ask smoking status; 17% always Arrange follow-up). Three 5As factors were identified- 'Helping', 'Assessing quitting' and 'Assessing dependence'. Responses to barrier/enabler items showed greater knowledge, skills, intentions, and confidence with Assessment than Assisting; endorsement for SCS as a priority and part of midwives' professional role; and gaps in training and organisational support for SCS. Nine barrier/enabler factors were identified. Of these, the factors of 'Capability' (knowledge, skills, confidence); 'Work Environment' (service has resources, capacity, champions and values SCS) and 'Personal priority' (part of role and a priority) predicted 'Helping'.
The TDF enabled systematic identification of barriers to providing SCS, and the multivariate models identified key contributors to poor implementation. Combined with qualitative data, these results have been mapped to intervention components to develop a comprehensive intervention to improve SCS.
吸烟是导致不良妊娠结局的最重要的可预防因素，但向孕妇提供戒烟支持（SCS）的情况很差。我们研究了助产士实施 SCS（5A-询问、建议、评估、协助、安排随访）的情况，以及报告的实施障碍/促进因素。
对澳大利亚新南威尔士州（NSW）提供产前护理的助产士进行在线匿名调查，评估他们提供 5A 情况以及实施障碍/促进因素，使用理论领域框架（TDF）。因子分析确定了 5A 背后的结构；以及障碍/促进因素。多元线性模型检验了障碍/促进因素与 5A 之间的关系。
在邀请的 750 名助产士中，有 150 名（20%）参加了调查。受访者更常见的是询问和评估，而不是建议、协助或安排随访（例如，77%的人总是询问吸烟状况；17%的人总是安排随访）。确定了三个 5A 因素-“帮助”、“评估戒烟”和“评估依赖”。对障碍/促进因素的回应显示，评估比协助更有知识、技能、意图和信心；支持 SCS 作为优先事项和助产士专业角色的一部分；以及 SCS 培训和组织支持方面的差距。确定了九个障碍/促进因素。其中，“能力”（知识、技能、信心）；“工作环境”（服务具有资源、能力、拥护者和重视 SCS）和“个人优先级”（角色的一部分和优先级）预测“帮助”。
TDF 能够系统地识别提供 SCS 的障碍，并通过多元模型确定了实施不力的关键因素。结合定性数据，这些结果已映射到干预组件中，以开发一项全面的干预措施来改善 SCS。
