Usual care in a multicentre randomised controlled trial of financial incentives for smoking cessation in pregnancy: qualitative findings from a mixed-methods process evaluation

McKell, J., Harris, F. M., Sinclair, L., Bauld, L., Tappin, D. M. and Hoddinott, P. (2022) Usual care in a multicentre randomised controlled trial of financial incentives for smoking cessation in pregnancy: qualitative findings from a mixed-methods process evaluation. BMJ Open, 12(12), e066494. (doi: 10.1136/bmjopen-2022-066494) (PMID:36600364) (PMCID:PMC9730354)

Abstract

Objectives: Financial incentives are recommended by the UK’s National Institute for Health and Care Excellence to aid smoking cessation in pregnancy. However, little is known about how implementation contexts might impact on their effectiveness. Variations in smoking cessation support (usual care) for pregnant women who smoke were examined qualitatively as part of a prospective process evaluation of the Cessation in Pregnancy Incentives Trial (CPIT III). Design: Longitudinal case studies of five CPIT III trial sites informed by realist evaluation. Setting: A stop smoking service (SSS) serving a maternity hospital constituted each case study, located in three UK countries. Participants: Data collection included semistructured interviews with trial participants (n=22), maternity (n=12) and SSS staff (n=17); and site observations and perspectives recorded in fieldnotes (n=85). Results: Cessation support (usual care) for pregnant women varied in amount, location, staff capacity, flexibility and content across sites. SSS staff capacity was important to avoid gaps in support. Colocation and good working relationships between maternity and SSS professionals enabled prioritisation and reinforced the importance of smoking cessation. Sites with limited use of carbon monoxide (CO) monitoring reduced opportunities to identify smokers while inconsistency around automatic referral processes prevented the offer of cessation support. SSS professionals colocated within antenatal clinics were available to women they could not otherwise reach. Flexibility around location, timing and tailoring of approaches for support, facilitated initial and sustained engagement and reduced the burden on women. Conclusions: Trial sites faced varied barriers and facilitators to delivering cessation support, reflecting heterogeneity in usual care. If financial incentives are more effective with concurrent smoking cessation support, sites with fewer barriers and more facilitators regarding this support would be expected to have more promising trial outcomes. Future reporting of trial outcomes will assist in understanding incentives’ generalisability across a wide range of usual care settings.

• Item Type: Articles
• Additional Information: Funding: This study was supported by the Chief Scientist Office of the Scottish Government, grant number HIPS/16/01/CSO; with partnership funding from Cancer Research UK, grant number C48006/A20863/CRUK; Health and Social Care Northern Ireland COM/5352/17; Northern Ireland Chest Heart & Stroke 2017_09; Health and Social Care Northern Ireland Public Health Agency (no grant number); Lullaby Trust P272; Scottish Cot Death Trust (no grant number).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Tappin, Professor David
• Authors: McKell, J., Harris, F. M., Sinclair, L., Bauld, L., Tappin, D. M., and Hoddinott, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 07 December 2022
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2022
• First Published: First published in BMJ Open 12(12): e066494
• Publisher Policy: Reproduced under a Creative Commons License