MOHMQuit Trial - Midwives and Obstetricians Helping Mothers to Quit Smoking

The MOHMQuit intervention MOHMQuit (Midwives and Obstetricians Helping Mothers to Quit) is a multicomponent, system-based intervention to increase provision of smoking cessation support to pregnant women attending public antenatal services, using the 5As approach (Ask, Advise, Assess, Assist and Arrange follow-up). MOHMQuit specifically targets identified barriers to providing smoking cessation support (SCS), and includes elements for midwives, Aboriginal health workers (AHWs), obstetricians and maternity service leaders, as well as systems supports. Based on previous research (Passey et al., 2020; Longman et al., 2018) and designed collaboratively with input from multiple stakeholders across the NSW Health system, the MOHMQuit intervention is a systems-change intervention which was designed using a theoretically informed intervention development process – the Behaviour Change Wheel (Michie, Atkins, & West, 2014). MOHMQuit has been designed to be a sustainable systems-change intervention to address gaps in the provision of SCS by clinicians and ensure ongoing support for SCS from service leaders. Further details regarding the development and design of the MOHMQuit intervention are provided in two published papers (Passey et al., 2021; Longman et al., 2021). The MOHMQuit intervention is provided over a three-month period, with ongoing support following this intervention period through the establishment of a community of practice. The intervention targets maternity service leaders (Midwifery Unit Managers, Clinical Midwifery Educators, Clinical Midwifery Consultants and the Obstetric Director) and clinicians (midwives, Aboriginal Health Workers, obstetricians and obstetric trainees) and has multiple components: All participants will be requested to complete two short online training modules developed by the NSW Health Education and Training Institute (HETI), prior to other components. These modules take approximately 30 minutes each to complete and address: NSW Health policy regarding SCS; knowledge of harms of smoking in pregnancy; the evidence for SCS; use of the 5As; and use of NRT in pregnancy. Clinical Midwifery Consultants (CMCs): Initial engagement prior to the implementation phase to clarify their role in supporting practice change and the MOHMQuit intervention. At each site, a one-hour ‘warm up’ meeting will be held eight weeks before implementation, followed by a second ‘warm up’ meeting two weeks before implementation at the site. These meetings will be held virtually online and be facilitated by several members of the research team. The midwifery partner investigators at each site will attend these meetings, and invite maternity service leaders to attend, namely the Midwifery Unit Manager (MUM), Clinical Midwifery Consultant (CMC), lead obstetrician at each site. The first warm-up meeting will cover: • Introduction to MOHMQuit • Planning for the training, including inviting participants, logistics of rostering, and models for delivering training. • Discussing how MOHMQuit training will work at their site, including training dates, follow-up support and mechanisms for capturing issues or problems to be addressed. COVID safety plan/any other safety issues For maternity service leaders: The maternity service leader component will be provided prior to the clinician components below, in order to maximise their support for the practice-change in their service. At each site, one 3-hour group workshop will be held with maternity service leaders (MUMs, CMCs, Clinical Midwifery Educators (CMEs) and obstetric leads). This workshop will cover: SCS leadership; reviewing eMaternity reports (eMaternity is the electronic medical record system used in maternity services and the reports provide local performance data on provision of SCS); action planning, including initial steps; developing care pathways for SCS; developing and maintaining champions; expectations regarding next steps and support for MOHMQuit within their service, including development of a plan with deadlines for actions. Training for the leadership group will be provided by a senior CMC who is part of the research team, and who has extensive experience in leadership, evidence-based practice and training within NSW maternity services, and with detailed knowledge of all components of the MOHMQuit intervention. Resources provided for their ongoing use will include: a template for generating eMaternity reports on provision of SCS in their clinic; guidance on use of the eMaternity reports for quality improvement; a clinic/service action planning tool; guidance on developing champions; and guidance on developing local care pathways. For midwives and Aboriginal Health Workers: Full-day workshop covering: the importance of providing SCS; how to provide effective SCS; how to use the MOHMQuit resources; using tools for self-monitoring provision of SCS and action planning; documentation of SCS in eMaternity. Training will be provided jointly by a CMC, and an accredited smoking cessation trainer, with experience specifically related to smoking in pregnancy. Resources provided for their ongoing use will include: 11 short videos demonstrating critical techniques in providing SCS; guidance on recording smoking information in eMaternity; information on NSW Quitline; summary guide of the 5As; Assist and arrange follow-up flip booklet; Helpful hints for clinicians; reference card to pin on badge holder; self-help booklet for use with women; NRT information sheets for clinicians; and NRT information for women. These evidence-based print and video resources were designed specifically for the MOHMQuit trial (Longman et al., 2021). For obstetricians and obstetric trainees: One hour workshop covering: the importance of providing SCS; how to provide effective SCS; how to use the MOHMQuit resources; documentation of SCS in eMaternity Training will be provided jointly by a CMC, and an accredited smoking cessation trainer, with experience specifically related to smoking in pregnancy. Resources provided for their ongoing use will include: 11 short videos demonstrating critical techniques in providing SCS; guidance on recording smoking information in eMaternity; information on NSW Quitline; summary guide of the 5As; Assist and arrange follow-up flip booklet; Helpful hints for clinicians; reference card to pin on badge holder; self-help booklet for use with women; NRT information sheets for clinicians; and NRT information for women. All MOHMQuit-specific training sessions are intended to be provided as face-to-face group training sessions. However, this may need to be revised in light of the COVID-19 pandemic and on-line or hybrid models will be considered, depending on circumstances. Regardless of mode of delivery, all participants will be provided with the relevant resources for use in their services. All clinicians (midwives, Aboriginal Health Workers (AHWs), obstetricians and obstetric trainees) providing antenatal care will be asked to participate in the relevant training, and training will be offered several times at each site to maximise opportunity for participation. Clinical Midwifery Educators (CMEs) will be provided training and resources to continue to deliver training to address issues of staff turnover or absence, in order to maximise sustainability of the intervention. The research team has developed a specific train-the-trainer resource pack for CMEs that includes all the materials used in the workshops for midwives, AHWs and obstetricians, (slides, instructional videos and printed resources) with instruction on how to run training, and how to adapt the training to different situations including for example, one-on-one support, half-hour brief team training, or the full one-day workshop. CMEs will attend the full one day training with the midwives and AHWs, and then an additional one hour training on how to provide the training themselves. Additionally, services will be encouraged to form a ‘Community of practice’ to provide additional and ongoing peer support and encouragement. One-hour Community of Practice (CoP) meetings will be held monthly on an online platform (Teams, Skype or zoom), for ongoing support regarding the implementation of MOHMQuit across all sites. Each site will be added to the CoP meetings five weeks after training occurs at their site. The CoP meetings are designed to facilitate peer support in implementing MOHMQuit, but also include support provided by the senior CMC who is part of the research team, and senior research team members. CoP meetings will be open to all midwifery leaders (MUMs, CMCs, CMEs), obstetric leaders and clinicians (midwives, obstetricians, obstetric trainees, and Aboriginal Health Workers) who attended the training. Attendees will be invited to attend at their discretion. Adherence to the intervention Attendance records will be kept for the leaders’ workshop and clinicians’ training in order to be able to accurately report numbers of participants at each site and implementation outcomes such as the Reach of the intervention. Participants will be provided with attendance certificates for their professional development records. References Longman, J. M., et al. (2018). https://doi.org/10.1016/j.midw.2017.12.016 Longman, J. M., et al. (2021). https://doi.org/10.3390/ijerph181910522 Michie, S., Atkins, L., & West, R. (2014). The Behaviour Change Wheel - A Guide to Designing Interventions. United Kingdom: Silverback Publishing. Passey, M. E., et al. (2020). https://doi.org/10.1186/s12884-020-02912-0 Passey, M. E., et al. (2021) https://doi.org/10.1186/s43058-021-00235-5