Development of a complex intervention for the maintenance of postpartum smoking abstinence: Process for defining evidence based intervention

Relapse to tobacco smoking for pregnant women that quit is a major public health problem. Evidence based approaches to intervention are urgently required. This study aimed to develop an intervention to be integrated into existing healthcare. A mixed methods approach included a theory driven systematic review identifying promising behaviour change techniques for targeting smoking relapse prevention, and qualitative focus groups and interviews with women, (ex-smokers who had remained quit and those who had relapsed), their partners, and healthcare professionals (N=74). A final stage recruited ten women to refine and initially test a prototype intervention. Our qualitative analysis suggests a lack but need for relapse prevention support. This should be initiated by a trusted ‘credible source’. For many women this would be a midwife or a health visitor. Support needs to be tailored to individual needs, including positive praise/reward, novel digital and electronic support, and partner or social support. Advice and support to use e cigarettes or nicotine replacement therapy for relapse prevention was important for some women, but others remained cautious. The resulting prototype complex intervention includes face to face support reiterated throughout the postpartum period, tailored digital and self-help support, and novel elements such as gifts and NRT.