Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T18:16:09.026Z Has data issue: false hasContentIssue false
  • English
  • Français

Dissonance and disengagement in pregnant smokers: a qualitative study

Published online by Cambridge University Press:  11 February 2013

Felix Naughton ,
Helen Eborall  and
Stephen Sutton
Felix Naughton*
Affiliation:
Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, UK
Helen Eborall
Affiliation:
SAPPHIRE (Social science APPlied to Healthcare Improvement REsearch) group, Department of Health Sciences, University of Leicester, Leicester, LE1 6TP, UK
Stephen Sutton
Affiliation:
Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, UK
*
Address for correspondence: Corresponding author: Felix Naughton, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, +44 (0)1223 769302, Fax +44 (0) 1223 762515, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: While numerous barriers to smoking cessation in pregnancy have been identified, less is known about the role of pregnant smokers’ beliefs in promoting and inhibiting abstinence. This study explored these beliefs and how they might interact with psychosocial factors related to pregnancy and antenatal care.

Methods: In-depth face-to-face semi-structured interviews were conducted with 20 women with experience of prenatal smoking. Grounded theory and the constant comparative approach guided the analysis towards a theoretical explanation of the women's experiences.

Results: Cognitive dissonance generated by the discrepancy between smoking-related prenatal harm beliefs and continued smoking was a strong motivator to quit. However, difficulty in quitting led many to resolve this dissonance by endorsing disengagement beliefs which downplayed the threat of smoking. Four main types of disengagement belief were identified. The tendency to endorse disengagement beliefs appeared to be influenced by two factors: uncertainty about how smoking caused foetal harm and reassurance from health professionals and others that reduced smoking was sufficient for harm minimisation.

Conclusions: Disengagement belief endorsement is common among pregnant smokers and enables the justification of continued smoking, potentially hindering efforts to quit. Increased promotion of complete abstinence by antenatal care professionals and health education interventions targeting risk comprehension and disengagement belief endorsement should be considered to promote greater efforts to quit among pregnant smokers.

Keywords

smoking cessationqualitativepregnancycognitive dissonancedisengagement beliefs
Type
Articles
Information
Journal of Smoking Cessation , Volume 8 , Issue 1 , June 2013 , pp. 24 - 32
Copyright
Copyright © The Authors 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abatemarco, D. J., Steinberg, M. B., & Delnevo, C. D. (2007). Midwives’ knowledge, perceptions, beliefs, and practice supports regarding tobacco dependence treatment. Journal of Midwifery & Women's Health, 52, 451–457. doi:10.1016/j.jmwh.2007.03.019Google Scholar
Abrahamsson, A., Springett, J., Karlsson, L., & Ottosson, T. (2005). Making sense of the challenge of smoking cessation during pregnancy: a phenomenographic approach. Health Education Research, 20, 367–378. doi:10.1093/her/cyg127Google Scholar
Arborelius, E., & Nyberg, K. (1997). How should midwives discuss smoking behaviour in pregnancy with women of low educational attainment? Midwifery, 13, 210–215. doi:10.1016/S0266–6138(97)80008-3Google Scholar
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84, 191–215. doi:10.1037//0033-295X.84.2.191CrossRefGoogle Scholar
Bandura, A., Barbaranelli, C., Caprara, G. V., & Pastorelli, C. (1996). Mechanisms of moral disengagement in the exercise of moral agency. Journal of Personality and Social Psychology, 71, 364–374. doi:10.1037//0033-295X.84.2.191Google Scholar
Benowitz, N. L., Jacob, P., Kozlowski, L. T. III, & Yu, L. (1986). Influence of smoking fewer cigarettes on exposure to tar, nicotine, and carbon monoxide. New England Journal of Medicine, 315, 1310–1313. doi:10.1056/NEJM198611203152102Google Scholar
Bull, L. (2007). Smoking cessation intervention with pregnant women and new parents (part 2): A focus group study of health visitors and midwives working in the UK. Journal of Neonatal Nursing, 13, 179–185. doi:10.1016/j.jnn.2007.07.003Google Scholar
Chapman, S., Wong, W. L., & Smith, W. (1993). Self-exempting beliefs about smoking and health: differences between smokers and ex-smokers. American Journal of Public Health, 83, 215–219. doi:10.2105/AJPH.83.2.215Google Scholar
Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research, 6 Suppl 2, S125–S140. doi:10.1080/14622200410001669187Google Scholar
Coleman, T., Cooper, S., Thornton, J. G., Grainge, M. J., Watts, K., Britton, J.et al. (2012). A randomized trial of nicotine-replacement therapy patches in pregnancy. New England Journal of Medicine, 366, 808–818. doi:10.1056/NEJMoa1109582Google Scholar
Cooke, M., Mattick, R. P., & Barclay, L. (1996). Predictors of brief smoking intervention in a midwifery setting. Addiction, 91, 1715–1725. doi:10.1111/j.1360-0443.1996.tb02274.xGoogle Scholar
Curry, S. J., McBride, C., Grothaus, L., Lando, H., & Pirie, P. (2001). Motivation for smoking cessation among pregnant women. Psychology of Addictive Behaviors, 15, 126–132. doi:10.1037//0893-164X.15.2.126CrossRefGoogle ScholarPubMed
Davison, C., Frankel, S., & Smith, G. D. (1992). The limits of lifestyle: re-assessing ‘fatalism’ in the popular culture of illness prevention. Social Science & Medicine, 34, 675–685. doi:10.1016/0277-9536(92)90195-VGoogle Scholar
Dijkstra, A., & Brosschot, J. (2003). Worry about health in smoking behaviour change. Behaviour Research and Therapy, 41, 1081–1092. doi:10.1016/S0005–7967(02)00244-9Google Scholar
Dijkstra, A., De Vries, H., Kok, G., & Rouackers, J. (1999). Self-evaluation and motivation to change: social cognitive constructs in smoking cessation. Psychology & Health, 14, 747–759. doi:10.1080/08870449908410762Google Scholar
Festinger, L. (1957). A Theory of Cognitive Dissonance. Stanford, California: Stanford University Press.CrossRefGoogle Scholar
Glover, M., Paynter, J., Bullen, C., & Kristensen, K. (2008). Supporting pregnant women to quit smoking: postal survey of New Zealand general practitioners and midwives’ smoking cessation knowledge and practices. New Zealand Medical Journal, 121, 53–65.Google ScholarPubMed
Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54, 493–503. doi:10.1037//0003-066X.54.7.493CrossRefGoogle Scholar
Graham, H. (1976). Smoking in pregnancy: the attitudes of expectant mothers. Social Science & Medicine, 10, 399–405. doi:10.1016/0037-7856(76)90097-4Google Scholar
Hall, S., Weinman, J., & Marteau, T. M. (2004). The motivating impact of informing women smokers of a link between smoking and cervical cancer: the role of coherence. Health Psychology, 23, 419–424. doi:10.1037/0278-6133.23.4.419Google Scholar
Haslam, C., & Draper, E. (2001). A qualitative study of smoking during pregnancy. Psychology, Health & Medicine, 6, 95–99. doi:10.1080/713690228Google Scholar
Heikkinen, H., Patja, K., & Jallinoja, P. (2010). Smokers’ accounts on the health risks of smoking: why is smoking not dangerous for me? Social Science & Medicine, 71, 877–883. doi:10.1016/j.socscimed.2010.05.036Google Scholar
Hettema, J. E., & Hendricks, P. S. (2010). Motivational interviewing for smoking cessation: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 868–884.Google Scholar
Hotham, E. D., Atkinson, E. R., & Gilbert, A. L. (2002). Focus groups with pregnant smokers: barriers to cessation, attitudes to nicotine patch use and perceptions of cessation counselling by care providers. Drug and Alcohol Review, 21, 163–168. doi:10.1080/09595230220139064Google Scholar
Kleinjan, M., van den Eijnden, R. J., Dijkstra, A., Brug, J., & Engels, R. C. (2006). Excuses to continue smoking: The role of disengagement beliefs in smoking cessation. Addictive Behaviors, 31, 2223–2237. doi:10.1016/j.addbeh.2006.02.012Google Scholar
Lendahls, L., Ohman, L., Liljestrand, J., & Hakansson, A. (2002). Women's experiences of smoking during and after pregnancy as ascertained two to three years after birth. Midwifery, 18, 214–222. doi:10.1054/midw.2002.0312Google Scholar
Lu, Y., Tong, S., & Oldenburg, B. (2001). Determinants of smoking and cessation during and after pregnancy. Health Promotion International, 16, 355–365. doi:10.1093/heapro/16.4.355Google Scholar
Mays, N., & Pope, C. (2006). Quality in qualitative health research. In Pope, C. & Mays, N. (Eds.), Qualitative Research in Health Care (pp. 82–101). Oxford: Blackwell Publishing Ltd. doi:10.1002/9780470750841.ch8Google Scholar
Michie, S., Churchill, S., & West, R. (2011). Identifying evidence-based competences required to deliver behavioural support for smoking cessation. Annals of Behavioral Medicine, 41, 59–70. doi:10.1007/s12160-010-9235-zGoogle Scholar
Miller, W. R. & Rollnick, S. (1991). Motivational Interviewing: Preparing People for Change. New York: Guildford Press.Google Scholar
National Institute for Clinical Excellence (2010). Quitting smoking in pregnancy and following childbirth, NICE public health guidance 26.Google Scholar
Naughton, F., Prevost, A. T., Gilbert, H., & Sutton, S. (2012). Randomised controlled trial evaluation of a tailored leaflet and SMS text message self-help intervention for pregnant smokers (MiQuit). Nicotine & Tobacco Research, 14, 569–577. doi:10.1093/ntr/ntr254Google Scholar
Oakes, W., Chapman, S., Borland, R., Balmford, J., & Trotter, L. (2004). ‘Bulletproof skeptics in life's jungle’: which self-exempting beliefs about smoking most predict lack of progression towards quitting? Preventive Medicine, 39, 776–782. doi:10.1016/j.ypmed.2004.03.001Google Scholar
Owen, L., McNeill, A., & Callum, C. (1998). Trends in smoking during pregnancy in England, 1992–7: quota sampling surveys. BMJ, 317, 728. doi:10.1136/bmj.317.7160.728Google Scholar
Owen, L., & Penn, G. (1999). Smoking and Pregnancy: A Survey of Knowledge, Attitudes and Behaviour 1992–1999 Health Education Authority.Google Scholar
Petersen, Z., Nilsson, M., Everett, K., & Emmelin, M. (2007). Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking. Midwifery, 25, 382–391.Google Scholar
Schneider, S., Huy, C., Schutz, J., & Diehl, K. (2010). Smoking cessation during pregnancy: a systematic literature review. Drug and Alcohol Review, 29, 81–90. doi:10.1111/j.1465-3362.2009.00098.xCrossRefGoogle ScholarPubMed
Silverman, D. (1989). Six rules of qualitative research: a post-romantic argument. Symbolic Interaction, 12, 215–230. doi:10.1525/si.1989.12.2.215CrossRefGoogle Scholar
Strauss, A., & Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. (2nd ed.) London: Sage.Google Scholar
Sutton, S. (1999). How accurate are smokers’ perceptions of risk? Health, Risk and Society, 1, 223–230. doi:10.1080/13698579908407020Google Scholar
Thyrian, J. R., Hannover, W., Roske, K., Scherbarth, S., Hapke, U., & John, U. (2006). Midwives’ attitudes to counselling women about their smoking behaviour during pregnancy and postpartum. Midwifery, 22, 32–39. doi:10.1016/j.midw.2005.04.003Google Scholar
Tod, A. M. (2003). Barriers to smoking cessation in pregnancy: a qualitative study. British Journal of Community Nursing, 8, 56–64.Google Scholar
Ussher, M., Etter, J. F., & West, R. (2006). Perceived barriers to and benefits of attending a stop smoking course during pregnancy. Patient Education and Counseling, 61, 467–472. doi:10.1016/j.pec.2005.06.021Google Scholar
Ussher, M., West, R., & Hibbs, N. (2004). A survey of pregnant smokers’ interest in different types of smoking cessation support. Patient Education and Counseling, 54, 67–72. doi:10.1016/S0738-3991(03)00197-6CrossRefGoogle ScholarPubMed