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Smoking cessation during pregnancy: a person-centred approach among disadvantaged women in South Africa
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Smoking remains a leading cause of premature, preventable death in South Africa killing 44 000 South Africans each year. Through the introduction of comprehensive tobacco control policies, the South African government has tried to reduce the death toll and a significant reduction in tobacco use has been recorded since its peak in the 1990’s. Smoking among women, however have remained unchanged, which calls for actions. Pregnant mothers are specifically vulnerable as their smoking detrimentally affects their own health as well as the health of their babies. This thesis gives an account of the role the antenatal care system could play in reducing the burden caused by cigarette smoking.

 

The overall aim was to contribute to an understanding of how a person-centred approach to smoking cessation among disadvantaged pregnant women with high smoking rates may influence smoking behaviour. The specific objectives were to confirm the high smoking rates of the target population, assess their readiness to quit, explore existing barriers and promoting factors towards smoking cessation efforts within the public antenatal health care system, and to qualitatively assess the attitudes and perceptions of disadvantaged pregnant women regarding a personcentred smoking cessation intervention.

 

The high smoking rates of the target population was confirmed based on a cross-sectional study at antenatal clinics in four main cities of South Africa. It focused on the prevalence of smoking during pregnancy and used the stages of change theory to identify their readiness to quit. Additional questions concerned pregnancy related disease experiences, socio-economic determinants of continued smoking as well as attitudes towards the existing clinic services and its possible role in smoking cessation. A qualitative interview study analyzed more in-depth barriers for two-way communication between pregnant mothers and midwives. Both these studies informed the design and development of a person-centred smoking cessation intervention delivered at four public sector antenatal clinics in Cape Town. The intervention was subjected to a comprehensive evaluation based on a combination of quantitative and qualitative measures. This thesis utilizes data from the qualitative process assessment part, comprising individual interviews and focus group discussions with pregnant women during the implementation period of the intervention.

 

The survey results pointed out a high prevalence of smoking of 46% amongst disadvantaged pregnant women, with varying readiness for behaviour change. Most women were in the contemplation stage of behaviour change and thus ready to quit. Many of the women felt positive about the role of the midwife as an antenatal care provider, but they did not have confidence in midwives concerning encouraging or supporting women to change addictive behaviour be it smoking, alcohol or other illegal substances. The qualitative research highlighted the need for revised curricula for health education and counselling. The analysis illustrated how the current situation created tension between clinic staff and pregnant women making women feel unworthy and thus leaving little room for changing behaviour. The in-depth interviews and the focus group discussions provided an analytical account of how the person-centred approach in this population was perceived by the women themselves. It illustrated that a multifaceted intervention programme, using peer counselors and educational material designed specifically for a given target population, can successfully bring about behaviour change. The intervention succeeded in shifting women’s perceptions of hopelessness into feelings of being empowered to face their addictions and competent to make a change. Though the intervention meant greater rapport with the midwives, involving peer counsellors was rated highly by the participating women. The women reported having used the educational material and attached a great value to the appropriateness of the material to their life situations, and the effectiveness of having it combined with counselling from a peer counsellor. This qualitative evaluation showed the importance of a multifaceted intervention approach, in helping women identify with their behaviour change.

 

The thesis highlights the importance of designing smoking cessation interventions that are specific to the needs of target populations. When smoking cessation efforts are included into routine antenatal services it is important that the target group inform the nature and specific components of the intervention.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2011. , 53 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1398
Keyword [en]
Stage of change theory, smoking, cessation interventions, peer counsellor
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-39595ISBN: 978-91-7459-135-4 (print)OAI: oai:DiVA.org:umu-39595DiVA: diva2:394216
Public defence
2011-02-18, Bergasalen, byggnad 27, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2011-02-04 Created: 2011-02-02 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Smoking cessation intervention among pregnant women in South Africa
Open this publication in new window or tab >>Smoking cessation intervention among pregnant women in South Africa
Show others...
2009 (English)In: African journal of Midwifery and women's health, Vol. 3, no 4, 181-186 p.Article in journal (Refereed) Published
Abstract [en]

The objective was to determine the practices and beliefs of disadvantaged women with high smoking rates, their perceptions of antenatal services and their preference for smoking cessation intervention materials. The readiness of smokers to quit, in terms of stages of change, was also determined.

The study took place in public sector antenatal clinics situated in Cape Town, Kimberley, Port Elizabeth, Johannesburg and Pretoria that provide care to predominantly women of mixed ancestral descent.

A cross-sectional survey was used. Data were collected via a self-administered questionnaire from pregnant women who were currently smoking, had quit smoking before or during pregnancy and who had never smoked.

A total of 796 women were interviewed of which 365 (45.9%) were smokers, 117 (14.7%) were quitters and 314 (39.4%) were non-smokers. Being in the pre-contemplation stage was reported by 28%, 36% indicated that they thought about quitting, while 36% said that they were in the preparation stage. Of the smokers and quitters 9.3% had stopped in the last 6 months (action stage), and 15% had stopped for longer (maintenance phase). 86% of women reported satisfaction with midwives and more than 60% rated interactive intervention methods such as support groups and talks by women who had stopped smoking most favourably.

Most women who smoked were contemplating or preparing to stop smoking. Intervention programmes should target these groups of women and midwives could be used to implement the interventions by facilitating support from women who had successfully quit.

Identifiers
urn:nbn:se:umu:diva-39380 (URN)
Available from: 2011-01-26 Created: 2011-01-26 Last updated: 2011-02-04Bibliographically approved
2. Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking
Open this publication in new window or tab >>Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking
2009 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 4, 382-391 p.Article in journal (Refereed) Published
Abstract [en]
Objective

to explore barriers to and possibilities for interactive communication between midwives and pregnant women regarding smoking behaviour during pregnancy.

Design

the study was based on a qualitative research design aiming at a Grounded Theory analysis of interviews with pregnant women.

Setting

public sector antenatal clinics in Cape Town, South Africa predominantly providing care to women of mixed ancestry.

Informants

in-depth interviews with 12 pregnant women purposively selected on the basis of smoking behaviour, age and marital status to reach maximum variation.

Findings

the findings indicated low levels of transparency and trust in antenatal visits. Lack of trust was related to categories such as conflicting personal capabilities and socio-cultural and medical expectations, combined with a didactic approach from caregivers. The unworthy woman was identified as the core category of the interviews describing how women feel in their relationship with midwives. A theoretical model illustrates possibilities for change in relation to an ideal situation where a supportive caregiver, congruent expectations and capabilities result in women feeling visible.

Key conclusions and implications for practice

culturally appropriate smoking cessation interventions should be of high priority. Training in patient-centred counselling for midwives is necessary for creating an open dialogue with pregnant mothers about their smoking habits. The time constraint experienced by midwives also suggests that other methods apart from midwife counselling should be investigated for inclusion in the clinical setting.

Keyword
Smoking; Pregnancy; Antenatal care; Qualitative; Self-reported smoking
Identifiers
urn:nbn:se:umu:diva-6666 (URN)10.1016/j.midw.2007.07.012 (DOI)17988769 (PubMedID)
Available from: 2007-12-17 Created: 2007-12-17 Last updated: 2017-12-14Bibliographically approved
3. Pregnant women's responses to a tailored smoking cessation intervention: turning hopelessness into competence
Open this publication in new window or tab >>Pregnant women's responses to a tailored smoking cessation intervention: turning hopelessness into competence
2010 (English)In: Global health action, ISSN 1654-9880, Vol. 3Article in journal (Refereed) Published
Abstract [en]

The intervention succeeded in shifting women from feeling pessimistic about ever quitting to feeling encouraged to try and quit. Informants rated the social support they received very highly and expressed the need for the intervention to become a routine component of clinic services.

Keyword
pregnancy; smoking cessation intervention
Identifiers
urn:nbn:se:umu:diva-39381 (URN)10.3402/gha.v3i0.5379 (DOI)000208160600004 ()21170293 (PubMedID)
Available from: 2011-01-26 Created: 2011-01-26 Last updated: 2011-02-04Bibliographically approved
4. Identifying with a process of change: a qualitative assessment of the components included in a smoking cessation intervention at antenatal clinics in South Africa
Open this publication in new window or tab >>Identifying with a process of change: a qualitative assessment of the components included in a smoking cessation intervention at antenatal clinics in South Africa
2013 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 7, 751-758 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: previous research has suggested that pregnant women prefer a person-centred approach for smoking cessation interventions. However few studies have illustrated the mechanism through which such an approach has an influence on quitting or reduction rates among pregnant women in resource poor settings. PURPOSE: to explore the role of different components included in a smoking cessation intervention delivered to disadvantaged pregnant women with high smoking rates attending public health antenatal clinics in South Africa. METHODS: a qualitative design consisting of focus-group discussion with women exposed to the intervention was used. Women were purposively selected from four antenatal clinics and one tertiary hospital to represent different experiences of the intervention. Focus group discussions with four groups of smokers and four groups of quitters were conducted and a total of 41 women were interviewed. Data were analysed using content analysis. MAIN FINDINGS: the main theme describing the intervention effect that emerged from the interviews was, 'Making identification with change possible'. The categories 'An impulse for change', 'An achievable recipe', 'A physical reminder' and 'A compassionate companion' further described how each intervention component was perceived by women and how it contributed to behaviour change. CONCLUSIONS: behaviour change interventions that are directly informed by the target population with regards to its design, content and delivery offer great opportunities for positive behaviour change. Women positively evaluated all the components employed in this intervention but rated the social support they received from peer-counsellors as the overriding aspect of the intervention.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Smoking, Quitting, Pregnancy, Peer counsellors
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-39594 (URN)10.1016/j.midw.2012.07.016 (DOI)000319456300010 ()23036867 (PubMedID)
Available from: 2011-02-02 Created: 2011-02-02 Last updated: 2017-12-11Bibliographically approved

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