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Table 2 Intervention components targeting patient behaviour

From: Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women

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
  1. BCT behaviour change technique; COM-B capability, opportunity, motivation-behaviour; ICAN QUIT in Pregnancy Indigenous Counselling and Nicotine QUIT in Pregnancy