Midwives' views on referring pregnant women to Quitline and their participation and engagement with smoking cessation services (Quitline)

Abstract Background Smoking during pregnancy is a major risk for stillbirth and adverse outcomes. In Australia, about 70% of women who smoke before 20 weeks of pregnancy continue after 20 weeks, with little change over the last decade. Women are more likely to quit when attending cessation programs, but Quitline referral rates remain low. The aim of this study is to examine the Quitline (a telephone-based smoking cessation service) referral process for pregnant women and to identify the barriers and facilitators that influence appointment attendance. Methods Semi-structured interviews across Queensland maternity services with midwives who refer pregnant women to Quitline. Midwives were recruited through information sessions, posters and QR code registration. Deductive analysis using the Theoretical Domains Framework, followed by inductive thematic analysis, was employed to identify factors affecting the Quitline referral process and barriers and facilitators that may influence women’s attendance at telephone appointments. Results Eighteen midwives were interviewed between December 2023 and June 2024. Five themes were identified and linked to two Theoretical Domains Framework domains. Midwives had a limited understanding of the Quitline referral process and available Quitline services. Barriers included a lack of education, limited appointment time, and resource unavailability. Midwives suggest that offering Quitline calls following antenatal appointments may reduce the time between referral and appointment, thereby increasing Quitline appointment uptake. Conclusions Some midwives said that they were unaware of how to refer pregnant women who smoke to Quitline or what services Quitline offers. They also mentioned limited access to Quitline resources and insufficient time during appointments to make referrals. Enabling women to speak directly with Quitline counsellors following antenatal appointments could increase referral and attendance rates. Developing a Quitline education program for midwives and establishing a national referral system could increase referral and appointment attendance rates among pregnant women who smoke.