title: Barriers and promoters of an evidenced-based smoking cessation counseling during prenatal care in Argentina and Uruguay.
abstract: In Argentina and Uruguay, 10.3 and 18.3 %, respectively, of pregnant women smoked in 2005. Brief cessation counseling, based on the 5A's model, has been effective in different settings. This qualitative study aims to improve the understanding of factors influencing the provision of smoking cessation counseling during pregnancy in Argentina and Uruguay. In 2010, we obtained prenatal care providers', clinic directors', and pregnant smokers' opinions regarding barriers and promoters to brief smoking cessation counseling in publicly-funded prenatal care clinics in Buenos Aires, Argentina and Montevideo, Uruguay. We interviewed six prenatal clinic directors, conducted focus groups with 46 health professionals and 24 pregnant smokers. Themes emerged from three issue areas: health professionals, health system, and patients. Health professional barriers to cessation counseling included inadequate knowledge and motivation, perceived low self-efficacy, and concerns about inadequate time and large workload. They expressed interest in obtaining a counseling script. Health system barriers included low prioritization of smoking cessation and a lack of clinic protocols to implement interventions. Pregnant smokers lacked information on the risks of prenatal smoking and underestimated the difficulty of smoking cessation. Having access to written materials and receiving cessation services during clinic waiting times were mentioned as promoters for the intervention. Women also were receptive to non-physician office staff delivering intervention components. Implementing smoking cessation counseling in publicly-funded prenatal care clinics in Argentina and Uruguay may require integrating counseling into routine prenatal care and educating and training providers on best-practices approaches.
authors.affiliation: Unidad de Investigación Clínica y Epidemiológica Montevideo, Hosp Clinicas, Av Italia s/n, Montevideo, Uruguay, mcolomar@unicem-web.org.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Colomar
authors.forename: Van T
authors.initials: VT
authors.lastname: Tong
authors.forename: Paola
authors.initials: P
authors.lastname: Morello
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Farr
authors.forename: Catalina
authors.initials: C
authors.lastname: Lawsin
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dietz
authors.forename: Alicia
authors.initials: A
authors.lastname: Aleman
authors.forename: Mabel
authors.initials: M
authors.lastname: Berrueta
authors.forename: Agustina
authors.initials: A
authors.lastname: Mazzoni
authors.forename: Ana
authors.initials: A
authors.lastname: Becu
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.forename: José
authors.initials: J
authors.lastname: Belizán
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
mesh_terms: D000328:Adult; D001118:Argentina; D001291:Attitude of Health Personnel; D003142:Communication; D003376:Counseling; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D010465:Perception; D011247:Pregnancy; D011248:Pregnancy Complications; D037841:Pregnant People; D011295:Prenatal Care / Q000379:methods*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D020377:Self Efficacy; D016540:Smoking Cessation / Q000379:methods*; D014583:Uruguay