What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England.
What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England.
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DOI：
10.1186/1748-5908-7-36
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发表时间：
2012-04-24
期刊：
影响因子：
--
通讯作者：
Araujo-Soares V
中科院分区：
文献类型：
--
作者：
Beenstock J;Sniehotta FF;White M;Bell R;Milne EM;Araujo-Soares V
在联合王国，每年约有5，000例流产和300例围产期死亡是由产妇吸烟造成的。在英格兰东北部，22%的妇女在分娩时吸烟，而全国只有14%。助产士有责任帮助孕妇戒烟。我们的目的是评估有关助产士在怀孕期间戒烟的作用的实施困难。一份自我完成的匿名调查被发送给英格兰东北部的所有助产士（n = 1，358），探讨了国家健康与临床卓越研究所（NICE）指南中建议的四种行为的实施困难的理论解释：（a）询问孕妇的吸烟行为，（B）提及戒烟服务，（c）提供有关吸烟行为的建议，以及（d）使用一氧化碳监测仪。关于米吉等人的问题的理论领域框架（TDF），描述了11个领域的假设行为决定因素（即，“知识”、“技能”、“社会/职业角色/身份”、“对能力的信念”、"对结果的信念“、”动机和目标“、”记忆“、”注意力和决策过程“、”环境背景和资源“、”社会影响“、”情感“和”自我调节/行动计划“）被用来描述感知的实施困难，预测自我报告的实施行为，并探索与人口统计学和职业变量的关系。总有效率为43%（n = 589）。在删除不直接参与提供戒烟服务的分娩单位助产士后，分析的问卷数量为364份。参与者报告说，几乎没有实施困难，对所有四种行为的积极性很高，并确定了戒烟工作与他们的作用。相对于其他TDF领域，助产士对从事这项工作的后果、环境背景和可用资源不太确定。所有领域都高度相关。主成分分析表明，一个单一的因素（'倾向行动'），来自所有领域，解释66%的理论领域的措施的方差。“行为倾向”预测了自我报告的行为“将所有吸烟的妇女......推荐给NHS戒烟服务”，并介导了人口统计学变量（如助产士的主要工作地点）与行为之间的关系。我们的研究结果促进了对促进和抑制助产士与戒烟有关的指导实施行为的理解，并将为当前实践和新干预措施的发展提供信息。使用TDF作为一个自我完成的问卷是创新的，这项研究支持以前的研究，TDF是一个适当的工具来了解医疗保健专业人员的行为。
Around 5,000 miscarriages and 300 perinatal deaths per year result from maternal smoking in the United Kingdom. In the northeast of England, 22% of women smoke at delivery compared to 14% nationally. Midwives have designated responsibilities to help pregnant women stop smoking. We aimed to assess perceived implementation difficulties regarding midwives’ roles in smoking cessation in pregnancy. A self-completed, anonymous survey was sent to all midwives in northeast England (n = 1,358) that explores the theoretical explanations for implementation difficulties of four behaviours recommended in the National Institute for Health and Clinical Excellence (NICE) guidance: (a) asking a pregnant woman about her smoking behaviour, (b) referring to the stop-smoking service, (c) giving advice about smoking behaviour, and (d) using a carbon monoxide monitor. Questions covering Michie et al.’s theoretical domain framework (TDF), describing 11 domains of hypothesised behavioural determinants (i.e., ‘knowledge’, ‘skills’, ‘social/professional role/identity’, ‘beliefs about capabilities’, ‘beliefs about consequences’, ‘motivation and goals’, ‘memory’, ‘attention and decision processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, and ‘self-regulation/action planning’), were used to describe perceived implementation difficulties, predict self-reported implementation behaviours, and explore relationships with demographic and professional variables. The overall response rate was 43% (n = 589). The number of questionnaires analysed was 364, following removal of the delivery-unit midwives, who are not directly involved in providing smoking-cessation services. Participants reported few implementation difficulties, high levels of motivation for all four behaviours and identified smoking-cessation work with their role. Midwives were less certain about the consequences of, and the environmental context and resources available for, engaging in this work relative to other TDF domains. All domains were highly correlated. A principal component analysis showed that a single factor (‘propensity to act’), derived from all domains, explained 66% of variance in theoretical domain measures. The ‘propensity to act’ was predictive of the self-reported behaviour ‘Refer all women who smoke……to NHS Stop Smoking Services’ and mediated the relationship between demographic variables, such as midwives’ main place of work, and behaviour. Our findings advance understanding of what facilitates and inhibits midwives’ guideline implementation behaviours in relation to smoking cessation and will inform the development of current practice and new interventions. Using the TDF as a self-completion questionnaire is innovative, and this study supports previous research that the TDF is an appropriate tool to understand the behaviour of healthcare professionals.
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