Specifying evidence-based behavior change techniques to aid smoking cessation in pregnancy

Behavioral support aids smoking cessation in pregnancy. However, it remains unclear which component behavior change techniques (BCTs) contribute to effectiveness or the extent to which these are applied in practice. This study aimed to examine (a) which BCTs were included in effective behavioral support interventions for pregnant smokers (b) the prevalence of use of these BCTs by the English Stop Smoking Services (SSSs).

From a Cochrane review of smoking cessation behavioral support in pregnancy, 7 interventions were identified as effective in that they increased the odds of cessation by at least 50%, and differences between intervention and control conditions were statistically significant. BCTs in each intervention were identified using an established taxonomy of BCTs. Thirteen treatment manuals from SSSs were coded for inclusion of BCTs.

Thirty-seven BCTs were identified across trials of behavioral support for pregnant smokers, with an average of 8 BCTs, and a range of 6-34 BCTs, per intervention. Eleven BCTs were present in at least 2 effective interventions (e.g., facilitate goal setting [n = 6], advise on social support [n = 2], action planning [n = 5], provide rewards contingent on successfully stopping smoking [n = 4]). Only 15.4% of treatment manuals from SSSs contained all 11 BCTs; 53.8% contained at least 6 of them.

While BCTs associated with effective interventions can be identified from systematically reviewed literature, English SSSs appear to use only a limited proportion of these in practice.