Exploring the barriers of quitting smoking during pregnancy: A systematic review of qualitative studies

Abstract

Smoking during pregnancy is widely known to increase health risks to the foetus, and understanding the quitting process during pregnancy is essential in order to realise national government targets. Qualitative studies have been used in order to gain a greater understanding of the quitting process and the objective of this systematic review was to examine and evaluate qualitative studies that have investigated the psychological and social factors around women attempting to quit smoking during pregnancy. Electronic databases and journals were searched with seven articles included in this review. The findings demonstrated that women were aware of the health risks to the foetus associated with smoking; however knowledge of potential health risks was not sufficient to motivate them to quit. Several barriers to quitting were identified which included willpower, role, and meaning of smoking, issues with cessation provision, changes in relationship interactions, understanding of facts, changes in smell and taste and influence of family and friends. A further interesting finding was that cessation service provision by health professionals was viewed negatively by women. It was concluded that there is a shortage of qualitative studies that concentrate on the specific difficulties that pregnant women face when trying to quit smoking.

Introduction

When women become pregnant this does not mean they will automatically quit smoking.1, 2 For example, Haslam et al.³ found that half of the women they interviewed could state without any prompting two or more health risks including breathing problems, congenital malformations, low birth weight, premature birth, low IQ and circulatory problems. Research demonstrating the associated risks are widely documented. These include increased risk of perinatal mortality and morbidity such as miscarriage, sudden infant death syndrome (SIDS), low birth weight, foetal abnormalities, lung disorders and premature birth.3, 4 However, despite having this knowledge, women still continue to struggle to quit smoking during pregnancy.

The government in the United Kingdom has a target of reducing smoking in pregnancy from 23% to 15% by 2010.⁵ National figures in Australia demonstrate an overall smoking rate of 17.3% in pregnancy with a decrease from an estimated 30% in the 1980s.6, 7 A national strategy is in place to reduce this further. The United States has a target to increase smoking cessation from 14% in 1998 to 30% by 2010.⁸ Despite existing interventions, pregnant women remain difficult to motivate and support in the quitting process, with research illustrating that only approximately 30% of pregnant smokers quit.1, 9 Women who attempt to change their smoking behaviours during pregnancy encounter numerous barriers.

Successfully quitting smoking does not solely involve managing nicotine dependence but also the management of the women's psychological and social environment.³ A great deal of emphasis has previously been placed on the model of biological addiction as a mechanism to quitting, and although showing some success, this may have also hindered investigation of other factors involved in the quitting process.⁴ A greater understanding of these factors will help researchers develop better smoking cessation interventions to help motivated women to quit.3, 10 Qualitative methods of research enable us to understand how people make sense of personal experiences and situations.¹¹ These methods are suited to exploring in-depth issues and generate rich data, which are useful in the development of new theories or new approaches and interventions.