Smokefree pregnancy toolkit: Evaluation research
Summary of findings
The toolkit and items in it have been ordered in large numbers, but this research suggests that it is not often being used by midwives or SSAs with their clients. This is not due to health professionals’ views of the individual items, many of which were in fact well liked; rather it is a result of… • midwives’ reactions to the way the toolkit is presented, and the process for reordering items • a feeling that the material is too basic for specialists to use The toolkit does appear to be widely used by SSAs during their training session with midwives, but issues with reordering have restricted the way that they would like to use it. Community midwives often seemed reluctant to discuss smoking in depth and generally felt it is the SSA’s role to do so, not theirs. They have a short amount of time in which to discuss smoking, and numerous other issues to cover. They have to carry a lot of material with them when they conduct home visits or move between clinics, and they do not see that many pregnant smokers, or at least cannot predict when they will see one and so need to discuss smoking. The toolkit is a thick A4 folder holding a number of items with the title ‘Everything you need to help pregnant women stop smoking’; this combination of factors often suggested to midwives that… • discussing smoking will take a long time and may be difficult – or at least does not reassure them that this will not be the case • the toolkit is really aimed at someone else whose role it is to help pregnant women stop smoking, and who has the time and inclination to do what appears to be required • the toolkit will be too bulky to be worth carrying around The reordering process for all items except the booklets, and low clarity about the way in which anything can be ordered, meant that midwives could not easily acquire items they wanted to give away. This greatly undermined their value, and made midwives less well disposed towards the toolkit in general. Moreover, midwives’ reasons for ordering the toolkits were often fairly ephemeral (curiosity, instructed to do so, ‘I got it because it was there’ etc), and SSAs often reported that referrals from midwives are lower than they should be, and that attendance at training sessions is sporadic. This suggests that many midwives who have ordered a toolkit have not ‘bought into’ the need for it, and have not been persuaded of this or shown how to use it at a training session. As a result, the barriers described above are not overcome, and they do not use the toolkit at all. Most SSAs used the toolkit for training only – they felt many of the items are too basic to add value to their discussions with clients. They approved of the toolkit as a training tool, and wanted to instruct and encourage midwives to use it, but were frustrated by an ordering process which prevents them from ordering toolkits in bulk and giving them to midwives. All this suggests that midwives would be more likely to use the toolkit with clients if it… • indicated more clearly that it could be used to help with the brief interventions they thought their role should involve • reassured them more effectively about their concerns that discussing smoking will be difficult and time consuming • made it clearer what could be given to clients as ‘freebies’, and how these should be reordered in bulk • were easier to carry around • is introduced to them in a training session so that only midwives who take smoking seriously enough to attend training, and who would therefore be most likely seriously to consider using the toolkit, receive one in the first place Response to the individual items was generally positive… • Mums and Partners booklets were well liked and widely used – albeit often independently of the toolkit • flash cards were valued and thought useful – midwives tended to build a conversation around them; SSAs used them to back up a point • fridge magnet and Pregnancy Support DVD were well liked in principle, not least as freebies that could be given to clients; many respondents were frustrated that they could not order them in bulk and give them out • Q&A booklet was popular, and particularly useful for midwives (SSAs thought it too basic for their own use); content and tone caused some confusion over how it should be used • campaign poster was widely used • views of the calendar were mixed – the left and right sections were liked independently, but many were unsure how they go together; more seriously its value was undermined by ordering restrictions which meant it could not be given to clients to take home • content of the Training Guide was liked, but rarely read, partly because the title suggested the sheet is not aimed at midwives • scan wallet was rarely thought worthwhile Minor alterations to many of the items can be suggested, but overall little seems to need changing. This research was inconclusive on the subject of the most appropriate tone and feel for the material. The current approach (darker and more emotionally hard-hitting) and the potential future approach (brighter, more hopeful and cheery), both received considerable support, usually at the expense of the other. A more hopeful tone would be well received and thought effective by many, but an equal number think this would lose the impact and emotional kick of the existing approach. Separately from this, however, a number saw value in revising the approach regularly, to keep messages fresh.
The overall purpose of the research was to examine users’ and non-users’ expectations and views of the toolkit as a whole, and their views and use of each item.
The Department of Health (DH) launched a toolkit for midwives and other health professionals at the beginning of 2009 to help them talk to pregnant women who smoke about how to stop. The toolkit contains samples of items to give to clients, and material for health professionals to use themselves. Indications are that the toolkit has been well received, and items intended for both clients and professionals have been re-ordered in large numbers. This prompted questions about how the toolkit is being used, how many need to be produced and what the folder and items are made of. DH also needed to understand which items are of greatest value to midwives, how items are used, and which should be prioritised. Qualitative research among midwives and stop smoking service professionals was required to review perceptions and use of the toolkit, and to provide this understanding.
Research was conducted into a toolkit for health professionals to aid conversations with pregnant smokers. The findings showed low uptake due to issues with presentation and it being too simplistic. Recommendations follow.
32 face to face depth interviews and 100 Short Qualitative Interviews (telephone)
Data collection methodology
Jan - Feb 2010