Understanding pregnant women’s adherence-related beliefs about Nicotine Replacement Therapy for smoking cessation: A qualitative study

Introduction:
Reducing smoking during pregnancy is a public health priority. Nicotine Replacement Therapy (NRT) is offered routinely to pregnant women who smoke in the UK. However, evidence of treatment efficacy in this population is weak, most likely due to poor adherence. Guided by the Necessity-Concerns Framework, we conducted a qualitative study to better understand pregnant women’s perceived needs and concerns regarding NRT use, with consideration of combination NRT.

Methods:
Semi-structured interviews were conducted by telephone with 18 pregnant or recently pregnant women in England and Wales, purposively sampled for different NRT-related experiences. Participants were recruited online via Facebook adverts and through a Stop Smoking Service. A hybrid approach of deductive and inductive thematic coding was used for analysis.

Results:
Findings were organised around three themes: 1) the role of motivation to stop smoking; 2) necessity beliefs about using NRT; and 3) concerns about NRT. Some women reported fluctuating motivation for stopping smoking which undermined their NRT use. Others used NRT to cut down the number of cigarettes they smoked. Reasons for low NRT necessity beliefs included: a preference for quitting unassisted, low or unrealistic expectations of efficacy and over-confidence in achieving cessation (necessity testing). Concerns included: safety, particularly around increased nicotine exposure with combination NRT, addictiveness, side effects and capability to use.

Conclusion:
Pregnant women have multiple necessity beliefs and concerns that influence their use of NRT. Targeting these, alongside increasing and maintaining motivation to quit smoking, will likely help optimise NRT use in pregnancy and improve quit rates.