How to improve smoking cessation support for pregnant women? Guideline implementation in The Netherlands

This study aimed to develop and evaluate plans for the implementation of the Dutch guideline 'Treatment of tobacco addiction and smoking cessation support for pregnant women'. Participatory action research was used for the development and evaluation of implementation plans for maternity collaboration units in the north of the Netherlands. Mixed methods were used to evaluate the implementation by using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. The maternity collaboration units implemented the intervention to refer pregnant women who smoke to a counsellor from addiction care. Twenty-one of the 50 midwifery care practices (42%) and two of the five obstetrics departments (40%) referred women to addiction care. The results showed that of the 558 women who smoked during pregnancy in 2021, 73 women (13%) were referred to addiction care, 58 (10%) started a coaching trajectory and 12 women of the 48 (25%) who finished a coaching trajectory stopped smoking. The results of interviews and focus groups gave insight into the challenges for referral and indicated that the communication between the midwife/counsellor and the pregnant woman is important for counselling. A minority of maternal care professionals referred women to a counsellor from addiction care and a small percentage of women managed to stop smoking. Opportunities in the repetition of implementation strategies and increasing skills in motivational interviewing for maternity care professionals could improve adoption of interventions in future implementation. To increase the effectiveness of the intervention, the counsellors could consider combining their counselling with nicotine replacement therapy, feedback or incentives.