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08 18, 2019;9 (8): e026037.

What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis.

Gillian Sandra Gould, Laura Twyman, Leah Stevenson, Gabrielle R Gribbin, Billie Bonevski, Kerrin Palazzi, Yael Bar Zeev
Author Information
  1. Gillian Sandra Gould: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia gillian.gould@newcastle.edu.au. ORCID
  2. Laura Twyman: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
  3. Leah Stevenson: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
  4. Gabrielle R Gribbin: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
  5. Billie Bonevski: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
  6. Kerrin Palazzi: Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
  7. Yael Bar Zeev: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia. ORCID
PMID: 31427313 DOI: 10.1136/bmjopen-2018-026037

Abstract

BACKGROUND: Pregnancy is an opportunity for health providers to support women to stop smoking.
OBJECTIVES: Identify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy.
DESIGN: A systematic review synthesising original articles that reported on (1) prevalence of health providers' performing the 5As ('Ask', 'Advise', 'Assess', 'Assist', 'Arrange'), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care.
DATA SOURCES: MEDLINE, EMBASE, CINAHL and PsycINFO databases searched using 'smoking', 'pregnancy' and 'health provider practices'.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies included any design except interventions (self-report, audit, observed consultations and women's reports), in English, with no date restriction, up to June 2017.
PARTICIPANTS: Health providers of any profession.
DATA EXTRACTION, APPRAISAL AND ANALYSIS: Data were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, 'often/always' and 'always/all'. Meta-regressions were performed of 5As for 'often/always'.
RESULTS: Of 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices 'often/always' were: 'Ask' (n=9) 91.6% (95% CI 88.2% to 95%); 'Advise' (n=7) 90% (95% CI 72.5% to 99.3%), 'Assess' (n=3) 79.2% (95% CI 76.5% to 81.8%), 'Assist (cessation support)' (n=5) 59.1% (95% CI 56% to 62.2%), 'Arrange (referral)' (n=6) 33.3% (95% CI 20.4% to 46.2%) and 'prescribing NRT' (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I) was 95.9%-99.1%. Meta-regressions for 'Arrange' were significant for year (p=0.013) and country (p=0.037).
CONCLUSIONS: Health providers 'Ask', 'Advise' and 'Assess' most pregnant women about smoking. 'Assist', 'Arrange' and 'prescribing NRT' are reported at lower rates: strategies to improve these should be considered.
PROSPERO REGISTRATION NUMBER: CRD42015029989.

Keywords

healthcare providers maternal health pregnancy smoking smoking cessation

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MeSH Term

Female
Humans
Maternal Health Services
Physicians
Pregnancy
Pregnancy Complications
Smoking Cessation
Journal Article Meta-Analysis Research Support, Non-U.S. Gov't Systematic Review
Article has an altmetric score of 11

Word Cloud

Created with Highcharts 10.0.0smoking95%providersCIhealthcessation2%womencarepregnancy5As'Ask''Advise''Assess''Arrange'includedHealth'often/always'supportpooledprevalencecomponentssystematicreviewreportedperforming'Assist'prescribingNRTDATAusingpercentagesMeta-regressions33meta-analysis5%3%8%'1%n=64%'prescribingNRT'p=0BACKGROUND:PregnancyopportunitystopOBJECTIVES:IdentifyprovidingsmokeDESIGN:synthesisingoriginalarticles1providers'nicotinereplacementtherapy2factorsassociatedSOURCES:MEDLINEEMBASECINAHLPsycINFOdatabasessearched'smoking''pregnancy''healthproviderpractices'ELIGIBILITYCRITERIAFORSELECTINGSTUDIES:Studiesdesignexceptinterventionsself-reportauditobservedconsultationswomen'sreportsEnglishdaterestrictionJune2017PARTICIPANTS:professionEXTRACTIONAPPRAISALANDANALYSIS:DataextractedappraisedHawkertoolMeta-analysesexample'always/all'performedRESULTS:3933papers54n=29 225participants:generalpractitionersobstetriciansmidwivesothers10countriesPooledstudiesreportingpracticeswere:n=9916%88n=790%7299n=3797681'Assistn=55956%62'Arrangereferral2046251238%Heterogeneity959%-99significantyear013country037CONCLUSIONS:pregnantlowerrates:strategiesimproveconsideredPROSPEROREGISTRATIONNUMBER:CRD42015029989implementedproviders?healthcarematernal

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