The development and evaluation of a smoking cessation programme for disadvantaged pregnant women in South Africa

Studies of smoking during pregnancy in South Africa have found exceptionally high smoking rates among disadvantaged women of mixed ethnic descent (46%) (Steyn et al., 1997; Petersen et al., 2009a). As a consequence, these women are at high risk of smoking-related pregnancy complications and poor birth outcomes. It has long been recommended that a smoking cessation intervention be developed specifically for this high risk group. There is strong evidence that best practice smoking cessation interventions for pregnant women can be effective in increasing quit rates, as well as in reducing the incidence of premature birth and low birth weight (Lumley et al., 2009). However, these interventions have only been studied in developed countries and it was unknown whether such programmes could be successfully applied to a South African setting. From 2002, the Medical Research Council of SA undertook a programme of research for the purposes of developing and evaluating a smoking cessation intervention, specifically for disadvantaged pregnant women attending public-sector, antenatal clinics in Cape Town. This thesis reports on several aspects of this research

Qualitative evaluation of primary care providers experiences of a training programme to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa

Abstract Background The global epidemic of non-communicable disease (NCDs) has been linked with four modifiable risky lifestyle behaviours, namely smoking, unhealthy diet, physical inactivity and alcohol abuse. Primary care providers (PCPs) can play an important role in changing patient’s risky behaviours. It is recommended that PCPs provide individual brief behaviour change counselling (BBCC) as part of everyday primary care. This study is part of a larger project that re-designed the current training for PCPs in South Africa, to offer a standardized approach to BBCC based on the 5 As and a guiding style. This article reports on a qualitative sub-study, which explored whether the training intervention changed PCPs perception of their confidence in their ability to offer BBCC, whether they believed that the new approach could overcome the barriers to implementation in clinical practice and be sustained, and their recommendations on future training and integration of BBCC into curricula and clinical practice. Methods This was a qualitative study that used verbal feedback from participants at the beginning and end of the training course, and twelve individual in-depth interviews with participants once they had returned to their clinical practice. Results Although PCP’s confidence in their ability to counselling improved, and some thought that time constraints could be overcome, they still reported that understaffing, lack of support from within the facility and poor continuity of care were barriers to counselling. However, the current organisational culture was not congruent with the patient-centred guiding style of BBCC. Training should be incorporated into undergraduate curricula of PCPs for both nurses and doctors, to ensure that counselling skills are embedded from the start. Existing PCPs should be offered training as part of continued professional development programmes. Conclusions This study showed that although training changed PCPs perception of their ability to offer BBCC, and increased their confidence to overcome certain barriers to implementation, significant barriers remained. It is clear that to incorporate BBCC into everyday care, not only training, but also a whole systems approach is needed, that involves the patient, provider, and service organisation at different levels

Pregnant women's responses to a tailored smoking cessation intervention: turning hopelessness into competence

Background: Cognitive behavioral interventions consisting of brief counseling and the provision of self-help material designed for pregnancy have been documented as effective smoking cessation interventions for pregnant women. However, there is a need to understand how such interventions are perceived by the targeted group. Aim: To understand the cognitive, emotional, and behavioral responses of pregnant women to a clinic-based smoking cessation intervention. Methods: In-depth interviews with women attending four antenatal clinics in Cape Town, South Africa, who were exposed to a smoking intervention delivered by midwives and peer counselors. Women were purposively selected to represent a variation in smoking behavior. Thirteen women were interviewed at their first antenatal visit and 10 were followed up and reinterviewed later in their pregnancies. A content analysis approach was used, which resulted in categories and themes describing women's experiences, thoughts, and feelings about the intervention. Results: Five women quit, five had cut down, and three could not be traced for follow-up. All informants perceived the intervention positively. Four main themes captured the intervention's role in influencing women's smoking behavior. The process started with ‘understanding their reality,’ which led to ‘embracing change’ and ‘deciding to hold nothing back,’ which created a basis for ‘turning hopelessness into a feeling of competence.’Conclusion: The intervention succeeded in shifting women from feeling pessimistic about ever quitting to feeling encouraged to try and quit. Informants rated the social support they received very highly and expressed the need for the intervention to become a routine component of clinic services

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Proceedings of the 13th annual conference of INEBRIA

CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.The original publication is available at https://ascpjournal.biomedcentral.comENGLISH SUMMARY : Meeting abstracts.https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0062-9Publisher's versio

Updated final technical report to RITC / Follow up activities to support the dissemination and implementation of the RITC-funded smoking cessation intervention for disadvantaged pregnant women

The Research for International Tobacco Control (RITC)-funded Smoking during Pregnancy Project was the only smoking cessation intervention of its kind in South Africa, and possibly in the developing world. The evaluation of its impact showed it to be effective and very well accepted by both pregnant women and midwives. This made the dissemination of the study’s findings, as well the exposure of the intervention model, materials and tools to other colleagues and organizations in the field, of increased importance. Dissemination of project outputs and outcomes are reviewed in this report

Smoking cessation intervention for disadvantaged pregnant women : final technical report to RITC

The development of this smoking cessation intervention integrated research findings of the formative research, as well as international, evidence-based best practice interventions for smoking cessation among pregnant women, along with behavioural change theory. The smoking cessation rates of 450 pregnant smokers exposed to the intervention were compared to the cessation rates of a comparison group of another 450 women, who received usual care at the same clinics the year before. The difference between the two groups was 11.7% (95%CI: 5.0% - 18.4%)

A situational analysis of training for behaviour change counselling for primary care providers, South Africa

CITATION: Malan, Z., Mash, B. & Everett-Murphy, K. 2015. A situational analysis of training for behaviour change counselling for primary care providers, South Africa. African Journal of Primary Health Care & Family Medicine, 7(1):1-10, doi:10.4102/phcfm.v7i1.731The original publication is available at http://www.phcfm.orgBackground: Non-communicable diseases and associated risk factors (smoking, alcohol abuse, physical inactivity and unhealthy diet) are a major contributor to primary care morbidity and the burden of disease. The need for healthcare-provider training in evidence-based lifestyle interventions has been acknowledged by the National Department of Health. However, local studies suggest that counselling on lifestyle modification from healthcare providers is inadequate and this may, in part, be attributable to a lack of training. Aim: This study aimed to assess the current training courses for primary healthcare providers in the Western Cape. Setting: Stellenbosch University and University of Cape Town. Methods: Qualitative interviews were conducted with six key informants (trainers of primary care nurses and registrars in family medicine) and two focus groups (nine nurses and eight doctors) from both Stellenbosch University and the University of Cape Town. Results: Trainers lack confidence in the effectiveness of behaviour change counselling and in current approaches to training. Current training is limited by time constraints and is not integrated throughout the curriculum – there is a focus on theory rather than modelling and practice, as well as a lack of both formative and summative assessment. Implementation of training is limited by a lack of patient education materials, poor continuity of care and record keeping, conflicting lifestyle messages and an unsupportive organisational culture. Conclusion: Revising the approach to current training is necessary in order to improve primary care providers’ behaviour change counselling skills. Primary care facilities need to create a more conducive environment that is supportive of behaviour change counselling.Publisher's versio