Introduction of ‘opt-out’ smoking cessation referrals in pregnancy: a qualitative evaluation of staff views

Abstract

To evaluate staff views on the implementation of an intervention involving routine carbon monoxide (CO) testing for pregnant women and ‘opt-out’ (whether requested or not) referrals to stop smoking services (SSS) with CO>4ppm. Interviews (n=17) with six antenatal clinic staff involved in ‘opt-out’ referrals at two times - before and during implementation; and five SSS staff, six-months afterwards. Data were analysed using framework analysis. Three main themes were identified: implementation; impact of referrals; future directions. Generally, staff felt referrals were less arduous to implement and better received than expected. The majority believed the intervention helped engage women motivated to quit and offered a unique chance to impart smoking cessation knowledge to hard-to-reach women, who might not otherwise contact SSS. Some improvements to the intervention were suggested. Results indicate that, with training and support, routine CO testing and ‘opt-out’ referrals can be successfully incorporated into the workload of antenatal and SSS staff. ‘Opt-out’ referrals could potentially help SSS engage hard-to-reach women and deliver consistent message about dangers of smoking in pregnancy.