BACKGROUND Smoking is the most important preventable cause of adverse pregnancy outcomes, but provision of smoking cessation support (SCS) to pregnant women is poor. We examined the association between midwives' implementation of SCS (5As - Ask, Advise, Assess, Assist, Arrange follow-up) and reported barriers/enablers to implementation. METHODS On-line anonymous survey of midwives providing antenatal care in New South Wales (NSW), Australia, assessing provision of the 5As and barriers/enablers to their implementation, using the Theoretical Domains Framework (TDF). Factor analyses identified constructs underlying the 5As; and barriers/enablers. Multivariate general linear models examined relationships between the barrier/enabler factors and the 5As factors. RESULTS Of 750 midwives invited, 150 (20%) participated. Respondents more commonly reported Asking and Assessing than Advising, Assisting, or Arranging follow-up (e.g. 77% always Ask smoking status; 17% always Arrange follow-up). Three 5As factors were identified- 'Helping', 'Assessing quitting' and 'Assessing dependence'. Responses to barrier/enabler items showed greater knowledge, skills, intentions, and confidence with Assessment than Assisting; endorsement for SCS as a priority and part of midwives' professional role; and gaps in training and organisational support for SCS. Nine barrier/enabler factors were identified. Of these, the factors of 'Capability' (knowledge, skills, confidence); 'Work Environment' (service has resources, capacity, champions and values SCS) and 'Personal priority' (part of role and a priority) predicted 'Helping'. CONCLUSION The TDF enabled systematic identification of barriers to providing SCS, and the multivariate models identified key contributors to poor implementation. Combined with qualitative data, these results have been mapped to intervention components to develop a comprehensive intervention to improve SCS.

中文翻译：

---

与向孕妇提供戒烟支持有关的因素-澳大利亚新南威尔士州助产士的横断面调查。

背景技术吸烟是不良妊娠结局的最重要的可预防原因，但是向孕妇提供的戒烟支持（SCS）较差。我们研究了助产士实施SCS（5As-询问，咨询，评估，协助，安排后续行动）与实施障碍/促成因素之间的关联。方法在澳大利亚新南威尔士州（NSW），对提供产前护理的助产士进行在线匿名调查，使用理论领域框架（TDF）评估5A的提供情况和实施这些障碍的因素。因子分析确定了构成5A的基础；和障碍/使能。多元通用线性模型检查了屏障/启用因子与5As因子之间的关系。结果邀请了750名助产士，其中150名（20％）参加。与建议，协助或安排随访相比，受访者更常报告“询问和评估”（例如，始终询问吸烟状况的占77％；始终安排随访的比率为17％）。确定了三个5As因素-“帮助”，“评估戒烟”和“评估依赖性”。对障碍/使能项目的回答显示，与评估相比，评估具有更大的知识，技能，意图和信心；认可SCS为优先事项，并且是助产士职业角色的一部分；SCS的培训和组织支持方面的差距。确定了九个屏障/启用因子。其中，“能力”的因素（知识，技能，信心）；“工作环境”（服务具有资源，能力，拥护者和价值观SCS）和“个人优先级”（角色的一部分和优先级）预计为“帮助”。结论TDF能够系统地确定提供SCS的障碍，而多元模型确定了导致实施不佳的关键因素。结合定性数据，这些结果已被映射到干预成分，以开发综合干预措施以改善SCS。