Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.
BMJ Open. 2024 Apr 5;14(4):e076725. doi: 10.1136/bmjopen-2023-076725.
Globally, guideline-recommended antenatal care for smoking cessation is not routinely delivered by antenatal care providers. Implementation strategies have been shown to improve the delivery of clinical practices across a variety of clinical services but there is an absence of evidence in applying such strategies to support improvements to antenatal care for smoking cessation in pregnancy. This study aims to determine the effectiveness and cost effectiveness of implementation strategies in increasing the routine provision of recommended antenatal care for smoking cessation in public maternity services.
A non-randomised stepped-wedge cluster-controlled trial will be conducted in maternity services across three health sectors in New South Wales, Australia. Implementation strategies including guidelines and procedures, reminders and prompts, leadership support, champions, training and monitoring and feedback will be delivered sequentially to each sector over 4 months. Primary outcome measures will be the proportion of: (1) pregnant women who report receiving a carbon monoxide breath test; (2) smokers or recent quitters who report receiving quit/relapse advice; and (3) smokers who report offer of help to quit smoking (Quitline referral or nicotine replacement therapy). Outcomes will be measured via cross-sectional telephone surveys with a random sample of women who attend antenatal appointments each week. Economic analyses will be undertaken to assess the cost effectiveness of the implementation intervention. Process measures including acceptability, adoption, fidelity and reach will be reported.
Ethics approval was obtained through the Hunter New England Human Research Ethics Committee (16/11/16/4.07; 16/10/19/5.15) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health policy-makers and health services to inform best practice processes for effective guideline implementation. Findings will also be disseminated at scientific conferences and in peer-reviewed journals.
Australian New Zealand Clinical Trials Registry-ACTRN12622001010785.
在全球范围内，指南推荐的戒烟产前护理并没有被产前护理提供者常规提供。已有的实施策略已被证明可以改善各种临床服务的临床实践的提供，但在应用这些策略支持改善妊娠期间戒烟的产前护理方面，证据尚缺乏。本研究旨在确定实施策略在增加公共产妇服务中常规提供戒烟建议的产前护理方面的有效性和成本效益。
将在澳大利亚新南威尔士州三个卫生部门的产妇服务中进行非随机分步楔形集群对照试验。实施策略包括指南和程序、提醒和提示、领导支持、拥护者、培训以及监测和反馈，将在 4 个月内陆续提供给每个部门。主要结果指标将是：（1）报告接受一氧化碳呼气测试的孕妇比例；（2）报告接受戒烟/复吸建议的吸烟者或近期戒烟者比例；（3）报告提供戒烟帮助（戒烟热线转介或尼古丁替代疗法）的吸烟者比例。通过每周在产前预约时随机抽取的女性进行横断面电话调查来衡量结果。经济分析将评估实施干预的成本效益。还将报告包括可接受性、采用、保真度和覆盖范围在内的过程指标。
亨特新英格兰人类研究伦理委员会（16/11/16/4.07；16/10/19/5.15）和原住民健康和医学研究理事会（1236/16）已获得伦理批准。试验结果将传播给卫生政策制定者和卫生服务机构，以告知有效实施指南的最佳实践流程。研究结果还将在科学会议和同行评议期刊上发表。
澳大利亚新西兰临床试验注册中心-ACTRN12622001010785。
