Table 2.

Intervention components targeting patient behaviour

Barriers to smoking cessation care	COM-B	TDF	Intervention function	BCTs	Translation of BCTs within the ICAN QUIT in Pregnancy intervention
Indigenous pregnant women report symptoms of nicotine dependence and withdrawal effects from attempts to quit. Increased nicotine metabolism in pregnancy can increase cigarette consumption and also requires higher doses of NRT	Physical capability	Physical skills	Education Enablement	Provide feedback on current behaviour and dependence levels Assess withdrawal symptoms Biofeedback with carbon monoxide readings Making a quit plan and/or setting quit date Advise on stop-smoking medication Enable clients to obtain free medication	Free NRT for physical addiction Videos on how to use different types of NRT
Aboriginal women lack detailed knowledge about the harms of smoking. Stressful life circumstances may also impact on a women’s psychological capability to quit. Historical antecedents of smoking in Indigenous communities, racism, health disparities and low socio-economic status can impair capability to quit	Psychological capability	Knowledge	Education	Provide information on consequences of smoking and smoking cessation Instruction on how to quit smoking Offer appropriate written materials	Health booklet, supportive counselling and videos showing effects of smoking on mother and child Discuss psychosocial contexts of smoking
		Cognitive and interpersonal skills	Persuasion	Facilitate goal setting Facilitate barrier identification and problem solving Facilitate relapse prevention and coping Facilitate action planning and develop quit plan Advise on conserving mental resources	Discussion of psychosocial context of smoking Build self-efficacy for quitting Culturally appropriate colouring-in pages for diversion and relaxation
		Memory, attention and decision	Environmental restructuring Enablement	Advise on avoiding social cues for smoking Elicit client views Provide reassurance	Text and video on how to make a smoke-free home Personalised quit plan and goal setting Patient resources
		Behaviour regulation	Enablement Modelling		Messages from salient others—peers and experts NRT to reduce withdrawal effects Carbon monoxide readings Videos of role models Counselling on stressors and triggers
Few positive role models, as Indigenous smoking prevalence is high Targeted messages preferred Existing media messages may lack salience. Not wanting to be ‘told what to do’. Didactic counselling styles are unwelcome	Reflective motivation	Social role/identity Belief about capability Belief about consequences Intentions Goals Optimism	Persuasion Education Enablement Incentivisation Modelling	Credible sources for messages Explain the importance of abrupt cessation Boost motivation and self-efficacy Rewards contingent on effort or progress Emphasise choice	Targeted salient messages Build self-efficacy Building response efficacy—stopping smoking is worthwhile Smoking as an addiction Link nicotine withdrawal and symptoms of ‘stress’ Emphasising choice to quit Resources and support Success stories and role models via videos Goal setting, quit plan and quit date Dealing with challenges
Change of role on becoming pregnancy positively reinforces need to quit. Protective attitudes to baby Cravings can impair motivation	Automatic motivation	Reinforcement			Self-rewards in quit plan Celebrating small wins Free NRT ameliorates withdrawal symptoms
Lack of optimism for quitting		Emotion	Environmental restructuring Persuasion Enablement		Addressing challenges in quit plan Emotive videos Free NRT ameliorates withdrawal/stress symptoms
Lack of access to services or presenting late to antenatal care Lack of targeted resources Lack of subsidised NRT Health providers not frequently offering assistance to quit	Physical opportunity	Environmental context Resources	Environmental restructuring Enablement Education	Advise on environmental restructuring Advise on changing routine	Trained providers to support their quit attempts Referrals to other services Flipchart Patient booklets
Few role models who have quit during pregnancy	Social opportunity	Social influences	Modelling	Provide normative information about others’ behaviour and experiences Advise on/facilitate use of social support	Involving family members Making a smoke-free home Increasing social support Positive peer role models through video stories

BCT behaviour change technique; COM-B capability, opportunity, motivation-behaviour; ICAN QUIT in Pregnancy Indigenous Counselling and Nicotine QUIT in Pregnancy