Health providers’ and pregnant women’s perspectives about smoking cessation support: a COM-B analysis of a global systematic review of qualitative studies

Ratika Kumar, Leah Stevenson, Judith Jobling, Yael Bar-Zeev, Parivash Eftekhari, Gillian S. Gould*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Background: Smoking cessation in pregnancy has unique challenges. Health providers (HP) may need support to successfully implement smoking cessation care (SCC) for pregnant women (PW). We aimed to synthesize qualitative data about views of HPs and PW on SCC during pregnancy using COM-B (Capability, Opportunity, Motivation, Behaviour) framework. Methods: A systematic search of online databases (MEDLINE, EMBASE, PsycINFO and CINAHL) using PRISMA guidelines. PW’s and HPs’ quotes, as well as the authors’ analysis, were extracted and double-coded (30%) using the COM-B framework. Results: Thirty-two studies included research from 5 continents: twelve on HPs’ perspectives, 16 on PW’s perspectives, four papers included both. HPs’ capability and motivation were affected by role confusion and a lack of training, time, and resources to provide interventions. HPs acknowledged that advice should be delivered while taking women’s psychological state (capability) and stressors into consideration. Pregnant women’s physical capabilities to quit (e.g., increased metabolism of nicotine and dependence) was seldom addressed due to uncertainty about nicotine replacement therapy (NRT) use in pregnancy. Improving women’s motivation to quit depended on explaining the risks of smoking versus the safety of quit methods. Women considered advice from HPs during antenatal visits as effective, if accompanied by resources, peer support, feedback, and encouragement. Conclusions: HPs found it challenging to provide effective SCC due to lack of training, time, and role confusion. The inability to address psychological stress in women and inadequate use of pharmacotherapy were additional barriers. These findings could aid in designing training programs that address HPs’ and PW’s attitudes and supportive campaigns for pregnant smokers.

Original languageAmerican English
Article number550
JournalBMC Pregnancy and Childbirth
Issue number1
StatePublished - Dec 2021

Bibliographical note

Funding Information:
This study was funded by a grant from Hunter Cancer Research Alliance, Australia. The funding body had no role in the design of the study, the collection, analysis, and interpretation of data or in writing the manuscript.

Publisher Copyright:
© 2021, The Author(s).


  • COM-B
  • Health professionals
  • Health services
  • Pregnant women
  • Qualitative
  • Smoking cessation


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