Development of ‘Baby, Me & NRT’: A behavioural intervention to improve the effectiveness of nicotine replacement therapy in pregnancy

Lisa McDaid, Joanne Emery, Ross Thomson, Tim Coleman, Sue Cooper, Anne Dickinson, Darren Kinahan-Goodwin, Lucy Phillips, Felix Naughton

Research output: Contribution to journalArticlepeer-review


Background: The effectiveness of nicotine replacement therapy (NRT) for smoking cessation in pregnancy is limited by inconsistent and incorrect use. This paper describes the development process for ‘Baby, Me & NRT’, a novel pregnancy-specific intervention aimed at enhancing adherence to NRT.  

Methods: An integrated approach to intervention development was used, combining evidence, theory, stakeholder feedback and tailoring principles. The process involved six iterative steps: 1) synthesising relevant published evidence and guidance, 2) collecting primary qualitative data on barriers and facilitators to NRT adherence along with potential intervention design features, 3) identifying relevant behavioural theories and mapping the evidence against these, 4) prioritising behavioural determinants identified in steps 1-2, generating intervention objectives, and identifying behaviour change techniques which target the prioritised determinants, 5) consulting with stakeholders on intervention components, key content and tailoring features, and 6) producing a prototype intervention along with implementation guidance.  

Results: The prototype intervention comprises of a multi-component, one-month cessation programme, which includes six enhanced behavioural support sessions delivered by a trained advisor, tailored text messages, a website and an illustrated booklet. It promotes the uptake of high-dose and combination NRT, emphasises the importance of adherence, addresses motivation to use NRT, proactively helps problem solve NRT use issues, and provides guidance on preventing and managing smoking lapses.  

Conclusion: The development process generated an evidence- and theory-guided intervention, designed with stakeholder input, aimed at improving NRT effectiveness for smoking cessation in pregnancy. The prototype intervention has since been optimised and is being evaluated in a randomised controlled trial.  

Implications: Clinical guidelines in the UK recommend the use of NRT in pregnancy, but it is not always used to the best effect. Improving adherence to NRT in pregnancy will likely increase its effectiveness and ultimately lead to higher levels of smoking cessation. Interventions which integrate the issue of NRT adherence into standard cessation support in pregnancy, such as ‘Baby, Me & NRT, are needed to overcome barriers to use.
Original languageEnglish
Pages (from-to)1770–1780
Number of pages11
JournalNicotine and Tobacco Research
Issue number11
Early online date22 Jun 2023
Publication statusE-pub ahead of print - 22 Jun 2023

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