We Have An App For That: Tobacco Cessation for Pregnant Women
Rationale/Background Recent advances in mobile communications have resulted in tools and applications which may assist women to learn about and modify health behaviors during pregnancy The association between tobacco and increased risk for low birth weight and premature birth is well established in the literature (CDC, 2001). Tobacco use varies by community and state; in 2011, about 16% of pregnant women in Spokane County smoked, compared to 9% in Washington State and the U.S. (Riffe & Conley, 2013). The regional health district is endeavoring to address issues negatively affecting pregnancy and birth outcomes, with particular focus on tobacco education and cessation for pregnant women.
Undertaking/best practice/approach/methods/process
A tobacco cessation application developed by a partnership of academics and providers in 2012 was beta tested in summer of 2013. Based on that feedback, the application was extensively revised and refined, and prepared for rerelease in spring of 2013.
Public health and private provider practices serving pregnant women were recruited and received orientation about the project, training about the 5As of tobacco cessation, and completed pre-tests regarding their practices’ policies and performance of tobacco cessation counseling and education. All pregnant women who were patients at the selected sites were invited to view and complete a survey about the application. Women were invited to choose a small baby gift after completing the survey.
Focus groups of the staff at participating sites were conducted following client data collection. Four focus groups were conducted with a total of 27 health providers. Fourteen of the providers also completed a post-test regarding their practices’ policies and performance of tobacco cessation. All surveys and pre and post-tests were analyzed using SPSS 22. Focus group data was read and themes identified by project staff.
Outcomes achieved/documented
The demographic characteristics of the sample did not differ significantly from the Spokane County birth cohort, with the exception of significantly MORE women (55 out of 210 or 26.2%) reporting tobacco use. Participants also reported that public AND private providers consistently asked about tobacco use, but were less likely to address each subsequent step of the 5A model (advise, assess, assist and arrange). There was no significant different between public and private providers on the diminished compliance with the 5Asl. Provider focus groups revealed acceptance of and interest in utilization of applications to support health education cessation.
Conclusions
Client participants and providers assessment of the module were positive. Both groups identified future module ideas, with breastfeeding and nutrition, marijuana, and e-cigarette use in pregnancy identified as target topics for future modules. The health department will pursue additional resources to expand the use of the module in provider practices and to develop additional modules, and asked the Birth Outcome Task Force to lead that effort. Future modules will be evaluated using the combined survey/focus group approach.