MRC PhD students

A patient-centred smoking cessation intervention: barriers and promoting factors for smoking cessation as perceived by pregnant women

Background
Studies by the MRC found that an alarming rate of women smoke during pregnancy. A study conducted in 1997 found that 47% of coloured women smoke, compared with 4% of black South African women and 3% of Asian women (Steyn et al., 1997). A separate study conducted by the MRC’s perinatal Mortality Unit, found that 43% of women of mixed races to be smoking during pregnancy (Viljoen et al., 2005).

To date, there has been no intervention for pregnant women from disadvantaged communities and the challenge is to adapt an evidence-based smoking cessation method for poor South African women. However, there is a need for an in-depth understanding of women’s views and perceptions about the current approach to smoking counselling at antenatal clinics.
The first two studies in this PhD-proposal aim to address these issues, and the preliminary analysis have been considered in the form of an intervention. However, there is concern about how the chosen intervention, which is based on the “Best Practice Guideline”, would work within the South African context. Studies III and IV of the proposal therefore aim to describe women’s responses to the patient-centred intervention.

Below is a more in-depth analysis of the phases of the study.

Paper I:
Knowledge, practices and beliefs of pregnant women regarding smoking during pregnancy (Phase 1, 2001)
A cross-sectional survey was conducted to determine the knowledge, practices and beliefs of pregnant women attending public sector antenatal clinics regarding smoking during pregnancy and opinions about smoking cessation interventions. The preliminary analysis indicated a 46% smoking prevalence among pregnant women, 15% quit, 39% were non-smokers and 69% reported living with other smokers.

Paper II:
Transparency and disclosure about smoking status – the views of pregnant women (Phase 1, 2003)
In-depth interviews were conducted with 12 pregnant women to study the barriers of communication between midwives and pregnant women.
Preliminary findings show that women do underestimate their smoking status, and they lack the self-efficacy to talk to midwives about smoking.

Paper III:
Cognitive, emotional and behavioural responses of pregnant women towards a smoking cessation intervention (Intervention phase, 2007)
In-depth interviews will be conducted to describe the cognitive, emotional and behavioural responses of pregnant women towards a smoking cessation intervention. Women will be interviewed on two occasions during the pregnancy; one shortly after the first intervention contact and another towards the end of the pregnancy.

Paper IV:
The role of a patient-centred smoking cessation intervention – pregnant women’s attitudes and perceptions.
Focus group discussions will be held to explore pregnant women’s attitudes to and perceptions of the intervention, and its role in influencing smoking behaviour.

Time plan:
Data for papers 1 and 2 have already been collected and further analysis will be done. Two manuscripts will be prepared during 2006. Data for papers 3 and 4 will be collected during 2007 and the manuscripts for these papers will be written in 2008.

Enquiries
Dr Nelia Steyn, nelia.steyn@mrc.ac.za
Ms Zainonisa Petersen, zaino.petersen@mrc.ac.za