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Abstract

Understanding barriers and facilitators to NHS adoption of nicotine replacement therapy-assisted smoking reduction for pregnant women unable to stop smoking

Aims: UK guidelines recommend that non-pregnant individuals who cannot quit smoking use nicotine replacement therapy to reduce their smoking. In pregnancy, nicotine replacement therapy is advised only for abrupt quit attempts. Given dose-dependent associations between heaviness of smoking and adverse birth outcomes, reduction may be preferable to no action when abstinence is unachievable. This study explored stop smoking experts’ views on adopting this harm-reduction approach in practice.

Method: Six focus groups were conducted with 36 smoking in pregnancy stakeholders. Experts involved in maternity care, stop smoking support, public health and commissioning were recruited across England and Wales. Thematic analysis of data was both deductive and inductive and informed by the Theoretical Domains Framework and the Capability, Opportunity, Motivation Behaviour (COM-B) model.

Results: Facilitators identified were that professionals could be supportive if quitting was the ultimate goal and risks of continued smoking were clearly communicated. It was also felt and that this approach could encourage ‘hard to reach’ populations to access support. Potential barriers to implementation were concerns that promoting reduction might deter some from quitting, and monitoring progress with reduction is problematic.

Conclusions: Reduction supported by nicotine replacement therapy was viewed as acceptable and pragmatic for some pregnant smokers, provided cessation remains the ultimate goal. Findings highlight key theoretical and practical considerations for intervention development, including the need for clear guidance and training. Limitations include the UK-specific sample and variation in service contexts.