Table 3.
Behaviour change techniques (BCTs) that gained consensus on appropriateness for use in practice, in order of ranking.
| Suggested technique | Very appropriate/appropriate | Total sum of ratings (mean) | Related barriers and facilitators category |
|---|---|---|---|
| Round two | |||
| In counselling sessions, provide women with non-judgemental, understanding and consistent support with the same advisor, whenever possible | 100% | 242 (4.94) | Aspects of cessation support |
| Assist women on choosing NRT that is right for them, ensure the correct dosage is prescribed/advised upon and provide clear instructions on how and when to use it | 100% | 239 (4.88) | Aspects of cessation support |
| Advise on how to use NRT products properly, explaining how these work and emphasise that they are safer than smoking during pregnancy | 100% | 238 (4.86) | Aspects of cessation support |
| Provide support early in pregnancy | 100% | 234 (4.78) | Aspects of cessation support |
| Assess and discuss cigarette dependence at the first appointment and tailor support accordingly | 100% | 233 (4.76) | Understanding of risks, addiction & withdrawal symptoms |
| Reinforce their ideas about wanting to bring up children in a smoke-free environment as being valid | 100% | 231 (4.71) | Motivation & self-efficacy |
| Discuss the risks of smoking and benefits of quitting during pregnancy | 100% | 231 (4.71) | Understanding of risks, addiction & withdrawal symptoms |
| Prompt the women to make plans to eliminate/avoid triggers to smoke | 100% | 231 (4.71) | Motivation & self-efficacy |
| Explain the difference between everyday stress and withdrawal symptoms and how NRT can ease these symptoms | 100% | 226 (4.61) | Understanding of risks, addiction & withdrawal symptoms |
| Highlight that experiences from past quit attempts can be turned into positive lessons for this one | 100% | 226 (4.61) | Motivation & self-efficacy |
| Identify women's feelings towards and possible impact of partners' continued smoking, encourage them to produce practical solutions regarding this | 98% | 221 (4.51) | Influence of significant others |
| Dedicate time in a session to ask questions and listen to women's views, summarise these views back to them | 98% | 231 (4.71) | Aspects of cessation support |
| Ensure that women and partners/family members are aware of the dangers of second hand smoke | 98% | 230 (4.69) | Influence of significant others |
| Boost their self confidence in being able to quit by giving praise and positive reinforcement | 98% | 230 (4.69) | Motivation & self-efficacy |
| Explore and help women find ways to manage negative feelings, such as boredom or stress | 98% | 229 (4.67) | Stress & general well-being |
| Help the women to feel confident in being able to experience time out or relieve boredom without a cigarette | 98% | 227 (4.63) | Stress & general well-being |
| Establish the stressors in women's lives and explore ways they can manage them | 98% | 226 (4.61) | Stress & general well-being |
| Assess women's knowledge and understanding of the risks and tailor information given accordingly | 97.9% | 220 (4.58) | Understanding of risks, addiction & withdrawal symptoms |
| Praise women for seeking help | 95.9% | 227 (4.63) | Aspects of cessation support |
| Explain that incorrect use of NRT, especially inadequate dosage, can lead to an unsuccessful quit attempt | 95.9% | 226 (4.61) | Aspects of cessation support |
| Assess women's levels of motivation to quit and establish ways to build on this | 95.9% | 225 (4.59) | Motivation & self-efficacy |
| Advise and support partners/family members to help establish smoke free home by smoking outside | 95.9% | 224 (4.57) | Influence of significant others |
| Encourage women to discuss issues surrounding mental well-being and help them to develop coping strategies around this; explain that quitting can lead to making such issues better | 95.9% | 220 (4.53) | Stress & general mental well-being |
| Assist women to plan alternative ways to reward herself for not smoking | 95.9% | 220 (4.53) | Motivation & self-efficacy |
| Provide support and guidance to help women find the best ways to talk to their family or friends and gain their support with a quit attempt | 95.9% | 219 (4.47) | Influence of significant others |
| Explain how smoking can affect mood | 95.9% | 218 (4.45) | Stress & general well-being |
| Explore the possible reasons for relapse and plan together to prevent this | 95.5% | 229 (4.67) | Motivation & self-efficacy |
| Encourage women to find alternatives to smoking when they are with partners, family members or friends who smoke | 93.9% | 228 (4.65) | Influence of significant others |
| Give praise to women who say they want to protect their unborn baby from the harm of smoking | 93.9% | 227 (4.63) | Motivation & self-efficacy |
| Be available and flexible for the women that you are providing cessation support to | 93.9% | 227 (4.63) | Aspects of cessation support |
| Encourage women's decisions to protect their babies | 93.9% | 220 (4.53) | Motivation & self-efficacy |
| Explain the possibility and nature of withdrawal symptoms and give ideas of how to manage them | 93.9% | 220 (4.53) | Understanding of risks, addiction & withdrawal symptoms |
| Offer routine CO screening at every counselling session and reinforce treatment based on the results. Highlight improvements in the results | 91.8% | 233 (4.76) | Aspects of cessation support |
| Advise partners/family members to smoke outside or vape when with her if they do not want to quit | 91.8% | 221 (4.51) | Influence of significant others |
| Assess the factors in women's lives that affect their ability to quit and offer practical advice to make quitting more achievable | 91.8% | 218 (4.45) | Motivation & self-efficacy |
| Ask the women to think about what they might gain from being a long term non-smoker | 91.8% | 215 (4.39) | Motivation & self-efficacy |
| Involve partners/family members in the treatment process; encourage them to quit with the women | 89.9% | 220 (4.53) | Influence of significant others |
| Explore with women why smoking is important to them and why it would be difficult for them to stop | 89.8% | 219 (4.47) | Motivation & self-efficacy |
| Explain to women that they will metabolise nicotine faster during pregnancy, how that will make them feel, and why support and NRT are important to help with this | 89.6% | 217 (4.52) | Aspects of cessation support |
| Explain to women that although smoking has become part of her life, once they have stopped for a while it will become less normal and they will feel differently about cigarettes | 87.8% | 205 (4.18) | Motivation & self-efficacy |
| Ensure women have a good understanding about the nature of addiction | 87.5% | 213 (4.44) | Understanding of risks, addiction & withdrawal symptoms |
| Assess the partner's/family members knowledge and understanding of the risks and tailor information given accordingly | 85.7% | 211 (4.31) | Influence of significant others |
| Explain that appetite can be altered when quitting and advise on exercise and healthy food choices | 85.7% | 199 (4.06) | Motivation & self-efficacy |
| Write smoking cessation notes/advice in handheld or other maternity notes to ensure continuity of care | 85.4% | 216 (4.50) | Aspects of cessation support |
| Reassure women that it can take a few attempts to quit and they can be successful this time with support and NRT | 83.7% | 212 (4.33) | Understanding of risks, addiction & withdrawal symptoms |
| Inform women that enduring the stress of quitting will be better for the baby than continuing to smoke | 75.5% | 199 (4.06) | Understanding of risks, addiction & withdrawal symptoms |
| Build on any sense of guilt, turn it into a positive reason for wanting to quit | 75.5% | 198 (4.04) | Stress & general well-being |
| Suggest that the women take up alternative activities which they could do alone or with a social group | 71.4% | 186 (3.78) | Aspects of cessation support |
| Discuss and provide support on how to control unhealthy weight gain when quitting smoking | 71.3% | 191 (3.90) | Motivation & self-efficacy |
| Round three | |||
| Explain the financial benefits of quitting | 88.4% | 221 (4.51) | Motivation & self-efficacy |