Barriers and Promoters of an Evidenced-Based Smoking Cessation Counseling During Prenatal Care in Argentina and Uruguay

Abstract

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.

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Acknowledgments

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.

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We declare no conflicts of interest.

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Correspondence to Mercedes Colomar.

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Colomar, M., Tong, V.T., Morello, P. et al. Barriers and Promoters of an Evidenced-Based Smoking Cessation Counseling During Prenatal Care in Argentina and Uruguay. Matern Child Health J 19, 1481–1489 (2015). https://doi.org/10.1007/s10995-014-1652-3

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Keywords

  • Qualitative research
  • Health personnel
  • Prenatal care
  • Smoking cessation counseling