title: Scolders, carers or friends: South African midwives' contrasting styles of communication when discussing smoking cessation with pregnant women.
abstract: OBJECTIVE
  to investigate how midwives are currently communicating with women about smoking during pregnancy with a view to involving them in a smoking cessation intervention in antenatal clinics.
  
  
  METHODS
  a qualitative study using individual, in-depth interviews for data collection.
  
  
  METHODS
  24 nurses providing antenatal care to pregnant smokers attending public sector clinics in five major cities in South Africa.
  
  
  RESULTS
  three archetypes of midwives, characterised by different styles of communication and approaches to smoking cessation, emerged from the analysis of the interview data. These were described as the 'Angry Scolders', the 'Benign Carers' and the 'Enthusiastic Friends'. The first type conformed to the traditional, authoritarian style of communication, where the midwife assumed a dominant, expert role. When women failed to comply with their advice, these midwives typically became angry and confrontational. The second type of midwife used a paternalistic communication style and emphasised the role of education in changing behaviour. However, these midwives had little confidence that they could influence women to quit. The third type embraced a patient-centred approach, consciously encouraging more interaction with their patients and attempting to understand change from their point of view. These midwives were optimistic of women's capacity to change and more satisfied with their current health education efforts than the first two types. The Benign Carers and Enthusiastic Friends were more open to participation in the potential intervention than the Angry Scolders.
  
  
  CONCLUSIONS
  the prevailing traditional, authoritarian style of communication is inappropriate for smoking cessation education and counselling as it provokes resistance and avoidance on the part of pregnant smokers. The paternalistic approach appears to be largely ineffectual, whereas the patient-centred approach elicits the most positive response from pregnant women and enhances the possibility of a trusting and cooperative relationship with the midwife. Midwives using this style are more open to fulfilling their role in smoking cessation.
  
  
  CONCLUSIONS
  smoking cessation interventions need to attend to not only what midwives say to pregnant women about smoking, but also how they communicate about the issue. The use of a patient-centred approach, such as brief motivational interviewing, is recommended as a means of improving counselling outcomes among pregnant smokers.
authors.affiliation: Chronic Diseases of Lifestyle Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, Cape Town, South Africa. matmurphy@telkomsa.net
authors.forename: Katherine
authors.initials: K
authors.lastname: Everett-Murphy
authors.forename: Jeske
authors.initials: J
authors.lastname: Paijmans
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.forename: Catherine
authors.initials: C
authors.lastname: Matthews
authors.forename: Maria
authors.initials: M
authors.lastname: Emmelin
authors.forename: Zaino
authors.initials: Z
authors.lastname: Peterson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000379:methods*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic / Q000379:methods*; D011209:Power, Psychological; D011247:Pregnancy; D011248:Pregnancy Complications / Q000451:nursing / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D013019:South Africa; D055815:Young Adult