Preventing return to smoking postpartum (PReS study) – development of an evidence based complex intervention for maintaining positive behaviour change

First published: 13 March 2019 | Last updated: 28 March 2019


Dr Caitlin Notley

Dr Caitlin Notley was successful in securing funding from the SSA for their first ever Post-Doctoral Fellowship post. She began a five year programme of work in May 2013, focusing on tobacco smoking relapse prevention. This work is a public health priority as most people who manage to successfully quit smoking in the short term will relapse back to smoking within 12 months. There are currently no effective interventions to prevent smoking relapse [1], either in the general population or amongst specific at risk populations, such as postpartum women [2]. Dr Notley’s mixed methods programme of work explores the phenomenon of smoking relapse and will develop an intervention to support women to stay abstinent from smoking postpartum.

As part of her fellowship Dr Notley has led and completed two linked research studies:

  • SHARPISH Q – Qualitative study of Self-help and Relapse Prevention in Smoking. This study collected qualitative process evaluation data alongside an HTA funded trial of a self-help relapse prevention intervention. The RCT was a randomised study (n=1407) exploring educational booklets for the specific purpose of preventing relapse to smoking. Process evaluation and qualitative investigation explored patient reported experiences of using the self-help materials, focusing on the response of individuals to the intervention being tested. Dr Notley completed and has widely disseminated the trial process evaluation findings and is undertaking further analytical work on patient experience of smoking lapse and relapse.
  • PReSeRVE – Postpartum Smoking Relapse Prevention Qualitative Systematic Review. This review synthesised patient reported barriers and facilitators for smoking relapse prevention and was published in Addiction:

Dr Notley has been successful in securing additional external funding from Cancer Research UK and the Medical Research Council to lead two further linked studies:

  • ECtra Study (E Cigarette Trajectories) Real world experiences of using e-cigarettes for avoiding relapse to smoking: success or failure. A qualitative study. (Notley, C, Dawkins, L, Holland, R).
  • Preventing Return to Smoking Postpartum (PReS Study) – Development of a complex intervention to sustain smoking cessation in postpartum women. (Notley, C, Ussher, M, Bauld, L, Holland, R, Naughton, F, Hardeman, W).

SSA fellowship funding has supported Dr Notley to lead and develop these interlinked research projects, and has provided her with opportunities for national and international collaboration with other research centres. The funding has enabled Dr Notley to develop her methodological expertise in qualitative research methods and systematic reviewing, through involvement with a supportive network of SSA academics.

[1] Hajek P, Stead LF, West R, Jarvis M, Lancaster T. Relapse prevention interventions for smoking cessation. Cochrane database of systematic reviews (Online) 2009(1):CD003999.
[2] Agboola S, McNeill A, Coleman T, Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction. 2010;105(8):1362-80.

Aims: The proportion of female ex-smokers relapsing to smoking by 6 months postpartum is as high as 94%. This mixed methods intervention development study aimed to develop a relapse prevention intervention, following MRC guidelines.

Methods: Phase 1: Review of smoking cessation in pregnancy and relapse prevention interventions to identify potentially effective behaviour change techniques (BCTs) as promising intervention components. Phase 2: qualitative feedback on draft intervention components from pregnant and post-partum women, partners and health professionals via focus groups and interviews. Phase 3: The prototype intervention was refined and developed with individual postpartum women using a person based approach.

Results: 5 reviews and 32 subsequently published RCTs were included in the review. 45 BCTs were coded. Analysis of frequency and saliency resulted in a list of 6 most promising BCTs associated with long-term smoking abstinence. A logic model and draft intervention components were developed. Feedback was gathered from 34 women, 5 partners and 12 health professionals in focus groups and interviews. Midwives were suggested as credible sources for introducing the intervention. A tailored approach to information giving and partner support was important to women. Objective evidence based advice on medication for relapse prevention, including the use of e-cigarettes is needed. There was support for ongoing electronic support postpartum.

Conclusions: In this presentation we demonstrate how review evidence and iterative qualitative research including person based co-production can be used to develop an evidence based prototype intervention, combining a mixture of clinical, behavioural and social support.



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Dr Caitlin Notley