Barriers and Promoters of an Evidenced-Based Smoking Cessation Counseling During Prenatal Care in Argentina and Uruguay
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In Argentina and Uruguay, 10.3 and 18.3 %, respectively, of pregnant women smoked in 2005. Brief cessation counseling, based on the 5A’s model, has been effective in different settings. This qualitative study aims to improve the understanding of factors influencing the provision of smoking cessation counseling during pregnancy in Argentina and Uruguay. In 2010, we obtained prenatal care providers’, clinic directors’, and pregnant smokers’ opinions regarding barriers and promoters to brief smoking cessation counseling in publicly-funded prenatal care clinics in Buenos Aires, Argentina and Montevideo, Uruguay. We interviewed six prenatal clinic directors, conducted focus groups with 46 health professionals and 24 pregnant smokers. Themes emerged from three issue areas: health professionals, health system, and patients. Health professional barriers to cessation counseling included inadequate knowledge and motivation, perceived low self-efficacy, and concerns about inadequate time and large workload. They expressed interest in obtaining a counseling script. Health system barriers included low prioritization of smoking cessation and a lack of clinic protocols to implement interventions. Pregnant smokers lacked information on the risks of prenatal smoking and underestimated the difficulty of smoking cessation. Having access to written materials and receiving cessation services during clinic waiting times were mentioned as promoters for the intervention. Women also were receptive to non-physician office staff delivering intervention components. Implementing smoking cessation counseling in publicly-funded prenatal care clinics in Argentina and Uruguay may require integrating counseling into routine prenatal care and educating and training providers on best-practices approaches.
KeywordsQualitative research Health personnel Prenatal care Smoking cessation counseling
We want to thank the institutions who kindly accepted to participate in this research. From Buenos Aires, Argentina: MV de Martinez Maternity Hospital, San Isidro Maternity Hospital, Ramon Carrillo Maternity Hospital, and Tigre Maternity Hospital. From Montevideo, Uruguay: Maternal and Child health Center 2, Badano Repetto Health Center, Jardines del Hipódromo Health Center, and Canzani Hospital. The study was supported through CDC cooperative agreement 5U48DP001948-04 (SIP09-18) to Tulane University. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of CDC.
Conflict of interest
We declare no conflicts of interest.
- 1.World Bank (Internet). (2014, April 10). Data on county and lending groups. http://data.worldbank.org/about/country-classifications/country-and-lending-groups#Upper_middle_income
- 2.Panamerican Health Organization (PAHO), Centers for Desease Control and Prevention (CDC), Instituo Nacional de Estadisticas y Censo (INDEC), Ministerio de salud Argentino. (2013). Global adult tobacco survey. Buenos Aires: Argentina.Google Scholar
- 3.World Health Organization (WHO) (Internet). (2010, February). Global adult tobacco survey (GATS) Uruguay fact sheet 2009 (cited 2014 Jul 22). http://www.who.int/tobacco/surveillance/fact_sheet_of_gats_uruguay_2010.pdf
- 5.U.S. Department of Health and Human Services. (2014). The health consequences of smoking: 50 years of progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.Google Scholar
- 10.Centers for Disease Control and Prevention. (2001). Women and smoking: A report of the surgeon general. Atlanta: U.S. Department of Health and Human Services.Google Scholar
- 12.Programa Nacional para el Control del Tabaco. (2009). Guía Nacional para el Abordaje del Tabaquismo, Uruguay. Uruguay: Ministerio de Salud Pública.Google Scholar
- 13.Ministerio de Salud. (2011). Guía Nacional de Tratamiento de la Adicción al Tabaco. Buenos Aires, Argentina: Ministerio de Salud.Google Scholar
- 15.Chamberlain, C., O’Mara-Eves, A., Oliver, S., Caird, J. R., Perlen, S. M., & Eades, S. J. et al. (2013). Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD001055.pub4.
- 16.PHS Guideline Update Panel, Liaisons, and Staff. (2008). Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline. Respiratory Care, 53(9), 1217–1222.Google Scholar
- 24.Gould, G. S., Munn, J., Watters, T., McEwen, A., & Clough, A. R. (2013). Knowledge and views about maternal tobacco smoking and barriers for cessationin Aboriginal and Torres Strait Islanders: A systematic review and meta-ethnography. Nicotine and Tobacco Research, 15(5), 863–874.PubMedCrossRefGoogle Scholar