Development of Baby, Me, & NRT: A Behavioral Intervention to Improve the Effectiveness of Nicotine Replacement Therapy in Pregnancy

Background The effectiveness of Nicotine Replacement Therapy (NRT) for smoking cessation in pregnancy is limited by inconsistent and incorrect use. This paper describes the development process for Baby, Me, & NRT, a novel pregnancy-specific intervention aimed at enhancing adherence to NRT. Methods An integrated approach to intervention development was used, combining evidence, theory, stakeholders' feedback, and tailoring principles. The process involved six iterative steps: (1) synthesizing relevant published evidence and guidance, (2) collecting primary qualitative data on barriers and facilitators to NRT adherence along with potential intervention design features, (3) identifying relevant behavioral theories and mapping the evidence against these, (4) prioritizing behavioral determinants identified in steps 1 and 2, generating intervention objectives, and identifying behavior change techniques which target the prioritized determinants, (5) consulting with stakeholders on intervention components, key content and tailoring features, and (6) producing a prototype intervention along with implementation guidance. Results The prototype intervention comprises of a multi-component, 1-month cessation programme, which includes six enhanced behavioral support sessions delivered by a trained advisor, tailored text messages, a website, and an illustrated booklet. It promotes the uptake of high-dose and combination NRT, emphasizes the importance of adherence, addresses motivation to use NRT, proactively helps problem solve NRT use issues, and provides guidance on preventing and managing smoking lapses. Conclusion The development process generated an evidence- and theory-guided intervention, designed with stakeholder input, aimed at improving NRT effectiveness for smoking cessation in pregnancy. The prototype intervention has since been optimized and is being evaluated in a randomized controlled trial.

Automated summary

This paper describes the development process of a novel pregnancy-specific intervention called Baby, Me, & NRT, aimed at enhancing adherence to Nicotine Replacement Therapy (NRT) for smoking cessation in pregnancy. An integrated approach combining evidence, theory, stakeholders' feedback, and tailoring principles was used to develop the intervention.