Clean air for babies: an integrated support system and app designed to increase perinatal smoking cessation

Aim and Objective Approximately 10% of pregnant Israeli women smoke. To date smoking cessation programs across Israel consist mainly of group interventions, but these have shown to be less effective during pregnancy due to the demand for intensive and immediate support. Smoking cessation during pregnancy is further complicated, as smoking while pregnant leads to feelings of guilt and shame. Such anxiety has been shown to lead to mood shifts and in some cases depression. Meuhedet is the third largest healthcare provider in Israel with over 1.2M members, many relatively young, with 30,000 births annually. One of our major concerns is perinatal smoking. We are currently developing an integrated support program consisting of two modules: a unique counsellor training program and a 6-week active intervention program, including use of a specialized app. We have already completed the counselor training program and are currently running the 6-week intervention program. We have partnered up with MindInnovations.co—a company focused on creating innovations in therapeutic care—in order to create the CBT-based app. The app provides motivation, knowledge, and skills by tracking progress, assigning tasks, and providing participants with a clear pathway towards their quit date. Methods Our counselor training program gave smoking cessation counselors practical clinical tools for delivering extensive emotional support to expectant mothers. This program integrated theoretical background with practical protocols to attend the patients’ intense emotional needs, based on current psychological theories (CBT, Narrative Therapy, Motivational Interviewing, Stages of Change and Mindset Theory). This was conducted over a 36-hour course to a group of experienced smoking cessation counselors. Our perinatal smoking intervention program is ongoing, and the app is in its final stages of development. Results Thirty-six smoking cessation counselors completed the training course. We used questionnaires to evaluate knowledge and skills pre-and post-intervention, and participant satisfaction. Satisfaction was very high (Mean=9.81/10 ;sd=0.48) with high correlation between all items. Most participants responded that the materials were new to them (2.21/4 on a scale of 1-4, with 1 being “highly agree”). Knowledge and skills increased from 5.93 to 8.86 (on a scale of 1-10, paired t-test; p<0.001). We are enthusiastic to report on the intervention program, as well as the app, in the coming months. Conclusions Our advanced training module for experienced counselors significantly increased their skills and met their expectations. Treatment commences at this period of time. Our presentation focuses on our consultation training module and our overall program, including our smoking cessation app. Funding The project is being funded by the Global Bridges organization

Bridging the gap: challenging attitudes towards smoking in pregnancy among healthcare professionals

Background Clean Air for Babies is a Global Bridges project to reduce smoking in pregnancy in a healthcare organization, 'Meuhedet', with 1.2M members. One aim is empowering health professionals to provide brief smoking cessation interventions. In this study we assessed the effectiveness of an education program for nurses and ultrasound technicians. Methods The program consists of 8 hours, and includes smoking and ETS effects during pregnancy, practical tools and behavioral interventions. Evaluation includes before and after questionnaires based on Global Bridges tools, and focus groups. We are at the initial stage of analysis. We will conduct another round of questionnaires 3 months post intervention. Results We conducted 6 courses for 120 maternal health nurses and 60 technicians. Qualitative analysis demonstrates ambivalence regarding ability to intervene (“This will damage the therapeutic space”) and identification with smokers (“I have seen how difficult it is to stop, my husband became unbearable.”). A second theme was hesitance in approaching Muslim or Jewish-Orthodox spouses due to gender-based hierarchies in the cultural context (“In our culture it is hard for the women to tell a man what to do…"). A common theme among technicians was insecurity regarding their role in smoking cessation. We completed analysis of 29 nurses´ questionnaires pre and immediately post intervention. Using paired-t-test analysis we found a significant improvement in the level of knowledge (mean knowledge items 3.27 to 4.38 on a scale of 5, p< 0.001). No difference was found in self efficacy or reported behavior. Conclusions Initial results indicate that it is possible to identify specific barriers among caregivers that create resistance to smoking cessation interventions. Addressing them creates an opportunity for real organizational change. The improvement in knowledge is indicative of the appropriateness of the training sessions. We expect that improvement in self efficacy and reported behavior at the 3 month evaluation