PDF(Pubmed)
Abstract：
BACKGROUND: Smoking during pregnancy increases the risk of multiple serious adverse infant, child and maternal outcomes, yet nearly 10% of Australian women still smoke during pregnancy. Despite evidence-based guidelines that recommend routine and repeated smoking cessation support (SCS) for all pregnant women, the provision of recommended SCS remains poor. Guidance on developing complex interventions to improve health care recommends drawing on existing theories, reviewing evidence, undertaking primary data collection, attending to future real-world implementation and designing and refining interventions using iterative cycles with stakeholder input throughout. Here, we describe using the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework to apply these principles in developing an intervention to improve the provision of SCS in Australian maternity services.
METHODS: Working closely with key stakeholders in the New South Wales (NSW) health system, we applied the steps of the BCW method then undertook a small feasibility study in one service to further refine the intervention. Stakeholders were engaged in multiple ways-as a core research team member, through a project Advisory Group, targeted meetings with policymakers, a large workshop to review potential components and the feasibility study.
RESULTS: Barriers to and enablers of providing SCS were identified in five of six components described in the BCW method (psychological capability, physical opportunity, social opportunity and reflective and automatic motivation). These were mapped to intervention types and we selected education, training, enablement, environmental restructuring, persuasion, incentivisation and modelling as suitable in our context. Through application of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects and Equity) in the stakeholder workshop, behaviour change techniques were selected and applied in developing the intervention which includes systems, clinician and leadership elements. The feasibility study confirmed the feasibility and acceptability of the midwifery component and the need to further strengthen the leadership component.
CONCLUSIONS: Using the BCW method combined with strong stakeholder engagement from inception resulted in transparent development of the MOHMQuit intervention, which targets identified barriers to and enablers of the provision of SCS and is developed specifically for the context in which it will be implemented. The intervention is being trialled in eight public maternity services in NSW.
METHODS: Working closely with key stakeholders in the New South Wales (NSW) health system, we applied the steps of the BCW method then undertook a small feasibility study in one service to further refine the intervention. Stakeholders were engaged in multiple ways-as a core research team member, through a project Advisory Group, targeted meetings with policymakers, a large workshop to review potential components and the feasibility study.
RESULTS: Barriers to and enablers of providing SCS were identified in five of six components described in the BCW method (psychological capability, physical opportunity, social opportunity and reflective and automatic motivation). These were mapped to intervention types and we selected education, training, enablement, environmental restructuring, persuasion, incentivisation and modelling as suitable in our context. Through application of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects and Equity) in the stakeholder workshop, behaviour change techniques were selected and applied in developing the intervention which includes systems, clinician and leadership elements. The feasibility study confirmed the feasibility and acceptability of the midwifery component and the need to further strengthen the leadership component.
CONCLUSIONS: Using the BCW method combined with strong stakeholder engagement from inception resulted in transparent development of the MOHMQuit intervention, which targets identified barriers to and enablers of the provision of SCS and is developed specifically for the context in which it will be implemented. The intervention is being trialled in eight public maternity services in NSW.
摘要：
背景：怀孕期间吸烟会增加多个严重不良婴儿的风险，儿童和产妇的结果，然而，近10%的澳大利亚女性在怀孕期间仍然吸烟。尽管有循证指南建议对所有孕妇进行常规和反复戒烟支持（SCS），推荐的SCS的提供仍然很差。关于制定复杂干预措施以改善医疗保健的指南建议借鉴现有理论，审查证据,进行主要数据收集，参与未来的现实世界实施，并使用迭代周期和利益相关者的投入来设计和完善干预措施。这里,我们描述了使用行为变化轮（BCW）和理论域框架将这些原则应用于制定干预措施以改善澳大利亚产妇服务中SCS的提供。
方法：与新南威尔士州（NSW）卫生系统的主要利益相关者密切合作，我们应用了BCW方法的步骤，然后在一项服务中进行了小型可行性研究，以进一步完善干预措施。利益相关者以多种方式参与其中-作为核心研究团队成员，通过一个项目咨询小组，与政策制定者举行有针对性的会议，审查潜在部件和可行性研究的大型研讨会。
结果：在BCW方法中描述的六个组成部分中的五个（心理能力，物理机会，社会机会和反思和自动动机)。这些被映射到干预类型，我们选择了教育，培训,启用，环境结构调整,说服,激励和建模适合我们的环境。通过应用APEASE标准(负担能力，实用性,有效性,可接受性,副作用和公平)在利益相关者研讨会上，选择并应用行为改变技术来开发包括系统在内的干预措施，临床医生和领导元素。可行性研究证实了助产部分的可行性和可接受性，以及进一步加强领导部分的必要性。
结论：使用BCW方法结合从一开始就强有力的利益相关者参与，导致MOHMQuit干预措施的透明发展，它的目标是确定提供SCS的障碍和促成因素，并且是专门为实施SCS的背景而开发的。这项干预措施正在新南威尔士州的八个公共生育服务中进行试验。
方法：与新南威尔士州（NSW）卫生系统的主要利益相关者密切合作，我们应用了BCW方法的步骤，然后在一项服务中进行了小型可行性研究，以进一步完善干预措施。利益相关者以多种方式参与其中-作为核心研究团队成员，通过一个项目咨询小组，与政策制定者举行有针对性的会议，审查潜在部件和可行性研究的大型研讨会。
结果：在BCW方法中描述的六个组成部分中的五个（心理能力，物理机会，社会机会和反思和自动动机)。这些被映射到干预类型，我们选择了教育，培训,启用，环境结构调整,说服,激励和建模适合我们的环境。通过应用APEASE标准(负担能力，实用性,有效性,可接受性,副作用和公平)在利益相关者研讨会上，选择并应用行为改变技术来开发包括系统在内的干预措施，临床医生和领导元素。可行性研究证实了助产部分的可行性和可接受性，以及进一步加强领导部分的必要性。
结论：使用BCW方法结合从一开始就强有力的利益相关者参与，导致MOHMQuit干预措施的透明发展，它的目标是确定提供SCS的障碍和促成因素，并且是专门为实施SCS的背景而开发的。这项干预措施正在新南威尔士州的八个公共生育服务中进行试验。
