title: Does government supervision improve stop-smoking counseling in midwifery practices?
abstract: BACKGROUND
  Smoking-cessation counseling during pregnancy is important to prevent smoking-related harm in pregnant smokers and their children. Therefore we evaluated the effects of an Inspectorate's supervision programme on the provision of smoking-cessation counseling by midwifery practices in the Netherlands. The supervision programme consisted of 3 elements: A) A deadline was announced by which all practices should comply with professional norms on such counseling (2011); B) A set of randomly selected practices were assessed using a questionnaire and a personal feedback report (2010); C) Another set of randomly selected practices were assessed through a site visit and a personal feedback report (2012).
  
  
  METHODS
  Programme A was evaluated in a before-after study, Programmes B and C were evaluated in a randomized controlled trial (RCT) with only a post-intervention measurement. Primary outcome was provision of smoking-cessation counseling through a minimal-intervention strategy (V-MIS). Linear and logistic regression models were used to analyze data from 233 primary-care midwifery practices.
  
  
  RESULTS
  A) After announcement of the deadline, Dutch midwifery practices reported significantly more provision of smoking-cessation counseling. For example, the use of V-MIS increased substantially from 28% to 80%; B) In practices that were assessed with a questionnaire, the provision of counseling improved partially compared to controls; C) The provision of counseling did not differ between practices that were visited and their controls. While the training participation rate in counseling by midwifery practices did not differ between the intervention and control groups, the rate increased significantly in all practices after the start of the supervision programme.
  
  
  CONCLUSIONS
  The provision of smoking-cessation counseling improved spectacularly in Dutch midwifery practices. Despite some limitations of our study, the Inspectorate's supervision programme is likely to have contributed to the improvements in provision of counseling.
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; s.oudewesselink@erasmusmc.nl.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Oude Wesselink
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands;
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: Dutch Health Care Inspectorate, Utrecht, The Netherlands;
authors.forename: Petra G J
authors.initials: PG
authors.lastname: Reulings
authors.affiliation: Dutch Health Care Inspectorate, Utrecht, The Netherlands;
authors.forename: H Renske
authors.initials: HR
authors.lastname: Wentzel
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands;
authors.forename: Vicki
authors.initials: V
authors.lastname: Erasmus
authors.affiliation: Dutch Health Care Inspectorate, Utrecht, The Netherlands; Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Paul B M
authors.initials: PB
authors.lastname: Robben
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands;
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D006076:Government; D006801:Humans; D008880:Midwifery / Q000458:organization & administration*; D009426:Netherlands; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires