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Feasibility and Acceptability of ‘Opt-In’ Referrals for Stop Smoking Support in Pregnancy

Campbell, Katarzyna Anna; Campbell, Katarzyna A.; Orton, Sophie; Bowker, Katharine; Cooper, Sue; Coleman, Tim

Feasibility and Acceptability of ‘Opt-In’ Referrals for Stop Smoking Support in Pregnancy Thumbnail


Katarzyna Anna Campbell

Senior Research Fellow

Sue Cooper

Professor of Primary Care


Background: International guidelines recommend that following an early-pregnancy 'opt-out' referral for smoking cessation support, pregnant women who smoke should also be offered referrals at subsequent antenatal appointments ('opt-in' referrals). We assessed feasibility and acceptability of introducing 'opt-in', self-referral forms to stop smoking services (SSS) in antenatal clinics. Method: A 'before-after' service evaluation and qualitative interviews. 'Opt-in' self-referral forms were distributed by reception staff to women attending antenatal ultrasound appointments. We collected hospital/SSS data for the study period and a comparison period 12 months prior. Reception staff were interviewed and data analyzed thematically. Results: Over 6500 women entered antenatal care in each period; ~15% smoked and ~50% of those who smoked were referred 20 to SSS at their first appointment. In the study period, 17.4% of women completed 'opt-in' forms, of these 17.3% smoked, 23.1% of those who smoked requested a referral. Staff thought new procedures had minimal impact on workload, but were easy to forget. They believed the pathway would be better delivered by midwifery staff, with additional information/advice to improve engagement. Conclusions: 'Opt-in' referrals in later pregnancy result in significant numbers of women who smoke indicating interest in smoking cessation support. Additional training and support is necessary to motivate reception staff to oversee self-referral pen-and-paper procedures effectively.

Journal Article Type Article
Acceptance Date Apr 11, 2019
Online Publication Date Apr 16, 2019
Publication Date Apr 2, 2019
Deposit Date Apr 15, 2019
Publicly Available Date Apr 15, 2019
Journal International Journal of Environmental Research and Public Health
Electronic ISSN 1660-4601
Publisher MDPI
Peer Reviewed Peer Reviewed
Volume 16
Issue 8
Article Number 1358
Pages 1-10
Keywords smoking cessation; pregnancy; 'opt-in' referrals
Public URL
Publisher URL


Feasibility and Acceptability of ‘Opt-In’ Referrals for Stop Smoking Support in Pregnancy (453 Kb)

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