title: Pregnant Women's Experiences and Views on an "Opt-Out" Referral Pathway to Specialist Smoking Cessation Support: A Qualitative Evaluation.
abstract: BACKGROUND
  Smoking in pregnancy remains an important and costly public health concern with policy makers worldwide researching methods to aid cessation. UK government guidelines recommend implementation of an "opt-out" (ie, whether requested or not) referral pathway for pregnant smokers to specialist smoking cessation support using carbon monoxide (CO) screening. This study explores the views of pregnant smokers who experienced this new pathway in one UK hospital trust.
  
  
  METHODS
  Eighteen semi-structured telephone interviews with women who experienced the opt-out pathway were undertaken. Data were analyzed thematically.
  
  
  RESULTS
  Three themes were identified relating to expectations, acceptability and impact of the pathway. Women were generally very accepting of the CO testing especially when it met their prior expectations and was perceived as being a routine component of antenatal care. They considered the visual feedback from the CO monitoring improved their motivation to quit. Views on the automatic referral for cessation support were divided with questions raised as to the removal of choice, with many women also expressing dissatisfaction about perceived lack of contact by Stop Smoking Services (SSS) following referral.
  
  
  CONCLUSIONS
  The opt-out pathway is potentially an acceptable addition to current practice. The women considered CO monitoring to be the most valuable element of the pathway. Women keen to engage with SSS desired a more efficient system of contact.
  
  
  CONCLUSIONS
  This study presents a unique insight into pregnant women's views on the implementation of opt-out referrals for smoking cessation. Introducing CO testing and opt-out referrals at the time of antenatal ultrasound examination can potentially increase motivation to stop smoking in pregnancy. The findings demonstrate that facilitating access to SSS was not always achieved, and further refinement is needed to ensure more effective contact procedures. Ensuring all women are fully informed prior to the CO testing may further improve both the impact of the opt-out referral pathway and the chance of successfully engaging with SSS.
authors.affiliation: Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom; mas229@medschl.cam.ac.uk.
authors.forename: Melanie
authors.initials: M
authors.lastname: Sloan
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Katarzyna A
authors.initials: KA
authors.lastname: Campbell
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Katharine
authors.initials: K
authors.lastname: Bowker
authors.affiliation: Division of Primary Care, D1411, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Coleman
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Sue
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom;
authors.forename: Barbara
authors.initials: B
authors.lastname: Brafman-Price
authors.affiliation: Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom;
authors.forename: Felix
authors.initials: F
authors.lastname: Naughton
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012907:Smoking / Q000523:psychology / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D006113:United Kingdom