Development of a narrative and image-based intervention delivered by text message to support smoking cessation in pregnant women (Preprint)
Authors: King Emma , Steele Mary , Abhyankar Purva , Cheyne Helen , Elders Andrew , Grindle Mark , Hapca Adrian , Jones Claire , O'Carroll Ronan , Williams Brian 
Published: September 2023

BACKGROUND

This paper describes the development process of the ‘SKIP IT’ text messaging intervention to promote smoking cessation during pregnancy. Smoking during pregnancy is a major risk to mother and infant health. Pregnant women who smoke are more likely to experience complications during pregnancy, and babies born to women who smoke are likely to experience ongoing health needs. Previous interventions for reducing smoking in pregnant women have shown limited effectiveness.

OBJECTIVE

The objective was to develop an effective intervention to promote smoking cessation during pregnancy by examining the complex set of needs for facilitating positive behaviour change. This included engaging with clinicians and the target group of pregnant smokers to ensure the intervention is feasible and acceptable.

METHODS

Due to the linear nature of this development methods and results are presented together.

RESULTS

Step 1: Literature review methods
A series of literature reviews were carried to explore existing psychological theory relating to smoking cessation during pregnancy. The result was six ‘elements’ that, if achieved, are likely to increase the likelihood of a successful quit attempt:
Step 2: Qualitative interviews
Qualitative interviews were conducted with key stakeholder groups. The setting for this qualitative work was one large maternity unit in Scotland. Evidence supporting each of the ‘elements’ developed from the literature review was present.
Step 3: Intervention development
Evidence from the literature reviews and qualitative interviews was collated and a prototype intervention was developed based on storytelling and images. The final intervention consisted of frequent text messages sent to participants from a fictional character, ‘Megan’, who was designed as a coping model. Images corresponding to the current size of the fetus were sent weekly.
Step 4: Alpha testing
The intervention underwent alpha testing where the intervention was taken to a wider stakeholder group for feedback.
The writing group refined the intervention to reflect changes to current smoking cessation technology, including e-cigarettes and extended the intervention to be delivered up to 6 weeks post-birth.
Step 5: Focus groups and user feedback
Qualitative user testing was carried out the two health boards. The views of the target group were used to develop an intervention that was demonstrated to be feasible in practice and both acceptable and engaging for participants.
Step 6: Refining texts and coding
Text messages were refined based on the user feedback. The final text messages were coded for the presence of Behavioural Change Techniques (BCTs) by two coders.

CONCLUSIONS

We have developed a narrative and image-based intervention delivering by text message with the aim of supporting smoking cessation in pregnant women. Importantly, the intervention is rooted in an in-depth understanding of the target group, and their needs.

CLINICALTRIAL

Trials registration ClinicalTrials.gov Protocol ID: RMS2119.