Table 2 Intervention components targeting patient behaviour
Barriers to smoking cessation care | COM-B | TDF | Intervention function | BCTs | Translation of BCTs within the ICAN QUIT in Pregnancy intervention |
|---|---|---|---|---|---|
Indigenous pregnant women report symptoms of nicotine dependence and withdrawal effects from attempts to quit. Increased nicotine metabolism in pregnancy can increase cigarette consumption and also requires higher doses of NRT | Physical capability | Physical skills | Education Enablement | Provide feedback on current behaviour and dependence levels Assess withdrawal symptoms Biofeedback with carbon monoxide readings Making a quit plan and/or setting quit date Advise on stop-smoking medication Enable clients to obtain free medication | Free NRT for physical addiction Videos on how to use different types of NRT |
Aboriginal women lack detailed knowledge about the harms of smoking. Stressful life circumstances may also impact on a women’s psychological capability to quit. Historical antecedents of smoking in Indigenous communities, racism, health disparities and low socio-economic status can impair capability to quit | Psychological capability | Knowledge | Education | Provide information on consequences of smoking and smoking cessation Instruction on how to quit smoking Offer appropriate written materials | Health booklet, supportive counselling and videos showing effects of smoking on mother and child Discuss psychosocial contexts of smoking |
Cognitive and interpersonal skills | Persuasion | Facilitate goal setting Facilitate barrier identification and problem solving Facilitate relapse prevention and coping Facilitate action planning and develop quit plan Advise on conserving mental resources | Discussion of psychosocial context of smoking Build self-efficacy for quitting Culturally appropriate colouring-in pages for diversion and relaxation | ||
Memory, attention and decision | Environmental restructuring Enablement | Advise on avoiding social cues for smoking Elicit client views Provide reassurance | Text and video on how to make a smoke-free home Personalised quit plan and goal setting Patient resources | ||
Behaviour regulation | Enablement Modelling | Messages from salient others—peers and experts NRT to reduce withdrawal effects Carbon monoxide readings Videos of role models Counselling on stressors and triggers | |||
Few positive role models, as Indigenous smoking prevalence is high Targeted messages preferred Existing media messages may lack salience. Not wanting to be ‘told what to do’. Didactic counselling styles are unwelcome | Reflective motivation | Social role/identity Belief about capability Belief about consequences Intentions Goals Optimism | Persuasion Education Enablement Incentivisation Modelling | Credible sources for messages Explain the importance of abrupt cessation Boost motivation and self-efficacy Rewards contingent on effort or progress Emphasise choice | Targeted salient messages Build self-efficacy Building response efficacy—stopping smoking is worthwhile Smoking as an addiction Link nicotine withdrawal and symptoms of ‘stress’ Emphasising choice to quit Resources and support Success stories and role models via videos Goal setting, quit plan and quit date Dealing with challenges |
Change of role on becoming pregnancy positively reinforces need to quit. Protective attitudes to baby Cravings can impair motivation | Automatic motivation | Reinforcement | Self-rewards in quit plan Celebrating small wins Free NRT ameliorates withdrawal symptoms | ||
Lack of optimism for quitting | Emotion | Environmental restructuring Persuasion Enablement | Addressing challenges in quit plan Emotive videos Free NRT ameliorates withdrawal/stress symptoms | ||
Lack of access to services or presenting late to antenatal care Lack of targeted resources Lack of subsidised NRT Health providers not frequently offering assistance to quit | Physical opportunity | Environmental context Resources | Environmental restructuring Enablement Education | Advise on environmental restructuring Advise on changing routine | Trained providers to support their quit attempts Referrals to other services Flipchart Patient booklets |
Few role models who have quit during pregnancy | Social opportunity | Social influences | Modelling | Provide normative information about others’ behaviour and experiences Advise on/facilitate use of social support | Involving family members Making a smoke-free home Increasing social support Positive peer role models through video stories |