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Table 1 Evidence statements from the NICE systematic review and the construct domains

From: 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

Construct domain

Evidence statement from NICE systematic review (12 studies service providers and 11 studies service users)

Action planning

No evidence statements relevant

Beliefs about capabilities

Evidence statement 6.

Evidence from four qualitative studies, three surveys, and a study narrative suggests that record-keeping practices and follow-up enquiry may be inconsistent amongst practitioners. Pregnant women smokers and recent mothers differed in their views regarding the frequency with which they should be asked about their smoking. (three studies service users, three studies service providers, and one narrative)

Beliefs about consequences

Evidence statement 3.

Five qualitative papers describe how the style or way that information/advice is communicated to pregnant women smokers can impact on how the advice or information is received. Concerns regarding advice being construed as nagging or preaching are reported, together with the recommendation that a more caring, empathetic approach may be helpful. (four studies service users, one study service providers)

Environmental context and resources

Evidence statement 8.

Two qualitative studies, seven surveys, and one narrative provide evidence that staff perceive that lack of time is a significant barrier to the implementation of smoking-cessation interventions. (nine studies service providers and one narrative)

Evidence statement 9.

One qualitative study, six surveys, and narrative from one study suggest that staff perceive that limited resources in the form of either staffing or patient education materials impact on the delivery of interventions. These papers report findings from Australia and the United States, with no UK studies, which may require consideration in terms of applicability to the UK context. (seven studies service providers and one narrative)


Evidence statement 1.

Two qualitative studies and five survey studies provide evidence that not all staff ask all pregnant women about their smoking status during consultations. (three studies service users and four studies service providers) Four studies provide evidence that staff may not ask about smoking status due to concerns regarding damaging the relationship between themselves and a pregnant woman. (two qualitative studies service users, one qualitative study service providers, and one narrative)


Evidence statement 5.

There is evidence from one qualitative study and two surveys that there is limited knowledge/availability/use of guidelines or protocols in practice. (two studies service providers).

There is evidence from one survey that having guidelines/protocols in place may be associated with an increase in the number of smoking interventions offered. (one study service providers)

Evidence statement 10.

Two qualitative studies and seven surveys suggest that staff perceptions regarding the limited effectiveness of interventions may impact on their delivery of services. (nine studies service providers)

Memory, attention, and decision processes

No evidence statements relevant

Motivation and goals

Evidence statement 2.

Five qualitative studies and three surveys provide evidence that the information and advice currently provided by health professionals is perceived as insufficient or inadequate by some women and by professionals themselves. There is the suggestion that advice could be more detailed and explicit and that professionals find discussion of individual smoking behaviours challenging. (five studies service users and three studies service providers)

Professional role and identity

Evidence statement 4.

One qualitative study and four surveys provide evidence that there is variance in practice amongst staff in regard to the type of intervention offered during and following a consultation, such as whether a leaflet is offered, whether there is referral on to a specialist programme, or whether ongoing personal support is offered. (two studies service users and three studies service providers)

Evidence statement 11.

Four surveys provide evidence that typical practice in regard to smoking cessation advice and management of care can vary between doctors and midwives.

It is reported that general practitioners (GPs) are more likely to advise women to quit smoking completely, whereas midwives are more likely to advise gradual reduction. Also, the evidence suggests that midwives are more likely to refer on to other agencies and record smoking status. GPs may be more likely than midwives to raise the subject of smoking at subsequent consultations. (four studies service providers)


Evidence statement 7.

Three qualitative studies, seven surveys, and one narrative report suggest that staff perceive that they have limited skills and knowledge to implement successful smoking-cessation interventions. (one study service users, nine studies service providers, and one narrative)

Social influences

No evidence statements relevant

  1. Evidence statement 12 was not included.
  2. One qualitative study and two narrative reports describe obstacles to pregnant women smokers accessing services as including the length of sessions, difficulty making telephone contact, and a lack of transport or child care.
  3. It is suggested that domiciliary or very local services, the provision of crèche facilities, appointment systems, or telephone counselling could be suitable service delivery options.