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Stop smoking practitioner consensus on barriers and facilitators to smoking cessation in pregnancy and how to address these: a modified Delphi survey

Fergie, Libby; Campbell, Katarzyna; Coleman-Haynes, Tom; Ussher, Michael; Cooper, Sue; Coleman, Tim


Clinical Trial Manager

Tom Coleman-Haynes

Michael Ussher

Professor of Primary Care


Pregnant women can experience barriers and facilitators towards achieving smoking cessation. We sought consensus from smoking cessation practitioners on how influential pre-identified barriers and facilitators can be on pregnant women's smoking behaviour, and how difficult these might be to manage. Suggestions for techniques that could help overcome the barriers or enhance the facilitators were elicited and consensus sought on the appropriateness for their use in practice.

Forty-four practitioners who provided cessation support to pregnant women completed a three-round modified Delphi survey. Round one sought consensus on the ‘influence’ and ‘difficulty’ of the barriers and facilitators, and gathered respondents' suggestions on ways to address these. Rounds two and three sought further consensus on the barriers and facilitators and on ‘appropriateness’ of the respondent-suggested techniques. The techniques were coded for behaviour change techniques (BCTs) content using existing taxonomies.

Barriers and facilitators considered to be the most important mainly related to the influence of significant others and the women's motivation & self-efficacy. Having a supportive partner was considered the most influential, whereas lack of support from partner was the only barrier that reached consensus as being difficult to manage. Barriers relating to social norms were also considered influential, however these received poor coverage of respondent-suggested techniques. Those considered the easiest to address mainly related to aspects of cessation support, including misconceptions surrounding the use of nicotine replacement therapy (NRT). Barriers and facilitators relating to the women's motivation & self-efficacy, such as the want to protect the baby, were also considered as being particularly easy to address. Fifty of the 54 respondent-suggested techniques reached consensus as being appropriate. Those considered the most appropriate ranged from providing support early, giving correct information on NRT, highlighting risks and benefits and reinforcing motivating beliefs. Thirty-three BCTs were identified from the respondent-suggested techniques. ‘Social support (unspecified)’, ‘Tailor interactions appropriately’ and ‘Problem solving’ were the most frequently coded BCTs.

Involving partners in quit attempts was advocated. Existing support could be potentially improved by establishing appropriate ways to address barriers relating to pregnant smokers' ‘social norms’. In general, providing consistent and motivating support seemed favourable.


Fergie, L., Campbell, K., Coleman-Haynes, T., Ussher, M., Cooper, S., & Coleman, T. (2019). Stop smoking practitioner consensus on barriers and facilitators to smoking cessation in pregnancy and how to address these: a modified Delphi survey. Addictive Behaviors Reports, 9,

Journal Article Type Article
Acceptance Date Jan 25, 2019
Online Publication Date Jan 29, 2019
Publication Date Jun 1, 2019
Deposit Date Jan 30, 2019
Publicly Available Date Mar 6, 2019
Journal Addictive Behaviors Reports
Electronic ISSN 2352-8532
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 9
Article Number 100164
Keywords Smoking cessation; Pregnancy; Modified Delphi practitioners' consensusBarriers/facilitators; Behaviour change techniques
Public URL
Publisher URL
Additional Information This article is maintained by: Elsevier; Article Title: Stop smoking practitioner consensus on barriers and facilitators to smoking cessation in pregnancy and how to address these: A modified Delphi survey; Journal Title: Addictive Behaviors Reports; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: Crown Copyright © 2019 Published by Elsevier Ltd.