Differential uptake of a smoking cessation programme disseminated to doctors and midwives in antenatal clinics

Aims. Two methods of dissemination (simple and intensive) were used to diss eminate a smoking cessation programme to doctors and midwives working in an tenatal clinics. This paper describes the differential uptake of the smokin g cessation programme by doctors and midwives. It investigates whether the number of smoking cessation interventions used differ due to the type of di ssemination. It also examines the frequency with which doctors and midwives provide smoking cessation interventions after dissemination. Design. Clini cs were randomized to the method of dissemination (simple or intensive). Pr e-post test design was used to examine the relationship between disseminati on method and professional status at baseline and follow-up. A baseline sur vey collected data on the use of smoking cessation intervention in the clin ics prior to dissemination. A follow-up survey was conducted 18 months afte r the dissemination. Setting. Twenty-three public hospital antenatal clinic s in NSW. Participants. All clinical staff (midwives and doctors) working i n the clinic during the 1-2-week survey period prior to dissemination and 1 8 months after the dissemination were asked to participate. The response ra te was 63% (223) at baseline and 64% (182) at follow-up. Only 48% of midwiv es and doctors at follow-up were working in the original clinic. Measures. The proportion of clinicians who initially adopted the programme; the propo rtion of clinicians who had used one or more programme components in the la st week); the number of types of smoking cessation intervention provided (m aximum = 13), and the estimated proportion of clients offered smoking cessa tion intervention. Findings. More midwives than doctors 'ever used' the pro gramme (76% vs. 25%) and continued to implement (58% vs. 22%) the programme 18 months after dissemination. Both midwives and doctors increased the num ber of types of smoking cessation intervention offered at follow-up compare d to baseline (mean difference 2.8). Midwives provided more smoking cessati on interventions than doctors at baseline (mean difference 0.9) and at foll ow-up (1.6), regardless of method used to disseminate the programme. Midwiv es' mean estimates of the proportion of clients offered interventions were greater than doctors' (midwives' 59% vs. doctors' 35%) at follow-up. Conclu sion. The dissemination of a smoking cessation programme increased the leve l of smoking cessation interventions used by doctors and midwives. Doctors and midwives differ in their uptake of smoking cessation programmes. This i nformation can be used to plan programme dissemination strategies in the fu ture.