Table 1 Intervention components targeting health provider behaviour
Barriers to smoking cessation care | COM-B | TDF | Intervention function | BCTs | Translation of BCTs within the ICAN QUIT in Pregnancy intervention |
|---|---|---|---|---|---|
Clinicians infrequently provide cessation support during pregnancy. Clinicians lack knowledge, skills and confidence to counsel women who smoke during pregnancy and to prescribe NRT. Lack of clinician training relevant to smoking cessation during pregnancy Women report infrequently receiving assistance from clinicians | Psychological capability | Cognitive and interpersonal skills | Education Training Enablement | Information on health, social, emotional and environmental consequences Information antecedents Instruction on how to perform behaviour | Webinar training on how to consult Indigenous pregnant smokers and prescribe NRT Training manual Videos of providers and patients |
Memory, attention and decision | Environmental restructuring | Restructuring physical environment Prompts, cues | Flipchart and desktop guide Patient resources | ||
Behaviour regulation | Modelling Incentivisation | Demonstration of behaviour Feedback on behaviour Rewarding completion | Audit and feedback about NRT prescribed CPD points for training | ||
Clinicians lack optimism that their treatment will be successful during pregnancy | Reflective motivation | Belief about capability Belief about consequences Optimism | Education Training Persuasion Enablement | Information on health, social, emotional and environmental consequences Credible source Persuasion about capability Framing/reframing Salience of consequences Social comparison Adding objects to the environment | Provide resources Smoking reframed as an addiction, not a choice Inform re standard practices and evidence-based practices Building self-efficacy Build response efficacy—it is worthwhile—NNT only 16–17 for quitting Motivational videos, testimonials and success stories Celebrating small wins and turning ‘near misses’ into success |
Automatic motivation | Reinforcement Emotion | Environmental restructuring Persuasion | Credible source Exposure Framing/reframing Social comparison | Provide resources Emotive videos of health providers and patients | |
Clinicians lack time and resources to provide smoking cessation care. Oral NRT is not subsidised in Australia forming a barrier to prescribing | Physical opportunity | Environmental context Resources | Environmental restructuring Enablement | Adding objects to the environment Problem solving Self-monitoring of behaviour | Free NRT samples and oral NRT vouchers Referral pads Flipchart and desktop guide Patient booklets |
Few clinicians perform comprehensive smoking cessation care so there are few role models | Social opportunity | Norms Social influences | Modelling Education and training | Social comparison Credible source Instruction on how to perform behaviour Self-monitoring of behaviour | Whole of service training Interactive webinar Audit and feedback Videos of positive attitudes of other health providers |