Developing content for a nicotine replacement therapy adherence intervention (NAI): qualitative research and consensus-building exercise
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Description: Although the prevalence of smoking in pregnancy has generally been decreasing in higher income countries, it is reported that in England, 11% of women continue to smoke throughout their pregnancy causing harm to themselves and their unborn child. Nicotine replacement therapy (NRT) is a well-established, effective cessation treatment in the general population, however, the evidence for NRT efficacy in pregnancy is weaker with poor adherence being the most plausible reason for NRT appearing less effective in pregnancy. Pregnant smokers’ poor adherence may be explained by their concerns about using nicotine and by substantial pregnancy-induced acceleration in the rate of nicotine metabolism which generates lower blood nicotine concentrations. Consequently pregnant smokers who use NRT experience stronger nicotine withdrawal symptoms and are more likely to stop NRT and re-start smoking. Aim: Through qualitative work we aim to understand pregnant smokers’ concerns regarding use of NRT in pregnancy as well as their reasons for believing that NRT is worth using in pregnancy (‘necessity beliefs’). In addition, we will gain a greater understanding of the techniques used by stop smoking practitioners for addressing smokers’ concerns or enhancing their ‘necessity beliefs’ and the reasons given for using these particular techniques. This new knowledge, combined with expert consensus on how pregnant smokers should use NRT to maximise effectiveness whilst remaining safer than smoking, will allow us to develop content (messages) for support strategies or behaviour change techniques which encourage pregnant smokers to use NRT in cessation attempts. The proposed new content or techniques will then be presented to pregnant women and stop smoking practitioners to understand potential barriers against and facilitators for integrating this content into the advice and routinely delivered behavioural support for pregnant smokers.