title: Health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research.
abstract: BACKGROUND
  Reducing smoking in pregnancy is a policy priority in many countries and as a result there has been a rise in the development of services to help pregnant women to quit. A wide range of professionals are involved in providing these services, with midwives playing a particularly pivotal role. Understanding professionals' experiences of providing smoking cessation support in pregnancy can help to inform the design of interventions as well as to improve routine care.
  
  
  METHODS
  A synthesis of qualitative research of health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and the post-partum period was conducted using meta-ethnography. Searches were undertaken from 1990 to January 2015 using terms for maternity health professionals and smoking cessation advisors, pregnancy, post-partum, smoking, and qualitative in seven electronic databases. The review was reported in accordance with the 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) statement.
  
  
  RESULTS
  Eight studies reported in nine papers were included, reporting on the views of 190 health professionals/key informants, including 85 midwives and health visitors. The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers or facilitators to an individual's ability to provide smoking cessation support to pregnant or post-partum women. Underpinning these factors was an acknowledgment that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessation
  
  
  CONCLUSIONS
  The review identifies a role for professional education, both pre-qualification and in continuing professional development that will enable individuals to provide smoking cessation support to pregnant women. Key to the success of this education is recognising the centrality of the professional-client/patient relationship in any interaction. The review also highlights a widespread professional perception of the barriers associated with helping women give up smoking in pregnancy, particularly for those in disadvantaged circumstances. Improving the quality and accessibility of evidence on effective healthcare interventions, including evidence on 'what works' to support smoking cessation in disadvantaged groups, should therefore be a priority. PROSPERO 2013: CRD42013004170.
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Flemming
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Graham
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, UK.
authors.forename: Dorothy
authors.initials: D
authors.lastname: McCaughan
authors.affiliation: Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Angus
authors.affiliation: Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Sinclair
authors.affiliation: Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA, UK. linda.bauld@stir.ac.uk.
authors.forename: Linda
authors.initials: L
authors.lastname: Bauld
mesh_terms: D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008880:Midwifery; D010465:Perception; D049590:Postpartum Period; D011247:Pregnancy; D037841:Pregnant People; D024382:Professional Role; D011369:Professional-Patient Relations; D036301:Qualitative Research; D016540:Smoking Cessation / Q000379:methods*
keywords: Health professionals; Meta-ethnography; Pregnancy; Qualitative research; Smoking; Systematic review