Differential uptake of a smoking cessation programme disseminated to doctors and midwives in antenatal clinics.
OBJECTIVE
Two methods of dissemination (simple and intensive) were used to disseminate a smoking cessation programme to doctors and midwives working in antenatal clinics. This paper describes the differential uptake of the smoking cessation programme by doctors and midwives. It investigates whether the number of smoking cessation interventions used differ due to the type of dissemination. It also examines the frequency with which doctors and midwives provide smoking cessation interventions after dissemination.


METHODS
Clinics were randomized to the method of dissemination (simple or intensive). Pre-post test design was used to examine the relationship between dissemination method and professional status at baseline and follow-up. A baseline survey collected data on the use of smoking cessation intervention in the clinics prior to dissemination. A follow-up survey was conducted 18 months after the dissemination.


METHODS
Twenty-three public hospital antenatal clinics in NSW.


METHODS
All clinical staff (midwives and doctors) working in the clinic during the 1-2-week survey period prior to dissemination and 18 months after the dissemination were asked to participate. The response rate was 63% (223) at baseline and 64% (182) at follow-up. Only 48% of midwives and doctors at follow-up were working in the original clinic.


METHODS
The proportion of clinicians who initially adopted the programme; the proportion of clinicians who had used one or more programme components in the last week); the number of types of smoking cessation intervention provided (maximum = 13), and the estimated proportion of clients offered smoking cessation intervention.


RESULTS
More midwives than doctors "ever used" the programme (76% vs. 25%) and continued to implement (58% vs. 22%) the programme 18 months after dissemination. Both midwives and doctors increased the number of types of smoking cessation intervention offered at follow-up compared to baseline (mean difference 2.8). Midwives provided more smoking cessation interventions than doctors at baseline (mean difference 0.9) and at follow-up (1.6), regardless of method used to disseminate the programme. Midwives' mean estimates of the proportion of clients offered interventions were greater than doctors' (midwives' 59% vs. doctors' 35%) at follow-up.


CONCLUSIONS
The dissemination of a smoking cessation programme increased the level of smoking cessation interventions used by doctors and midwives. Doctors and midwives differ in their uptake of smoking cessation programmes. This information can be used to plan programme dissemination strategies in the future.
Midwifery Practice and Research Unit, St George Hospital, James Laws House, Kogarah, New South Wales 2217, Australia. cookem@sesahs.nsw.gov.au
M
M
Cooke
R P
RP
Mattick
R A
RA
Walsh
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D004059:Diffusion of Innovation; D004502:Education, Medical, Continuing / Q000379:methods*; D004509:Education, Nursing, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D016540:Smoking Cessation