Implementation of the 'Fresh Start' smoking cessation programme to 23 antenatal clinics: a randomized controlled trial investigating two methods of dissemination

The aim of the research was to investigate the effect of two methods of dis semination on the implementation of a smoking cessation programme and use o f smoking cessation interventions in antenatal clinics. A repeated-measures randomized design was used. Hospital antenatal clinics (n = 23) were rando mized to simple or intensive dissemination groups. All clinics in NSW with > 500 births were asked to participate. A survey of all clinical staff (n = 323) in 23 antenatal clinics was carried out prior to programme disseminat ion and 18 months after dissemination (n = 283). The response rate was 63% at baseline and 64% at follow-up. Smoking cessation intervention significan tly increased after dissemination. (F (18,1) = 49.26, p < 0.001). The avera ge number of smoking cessation interventions provided by clinics after prog ramme dissemination increased from 4.5 to 7.48 (mean difference 2.98, t( 19 ) 7.08, n < 0.001, 95% CI (2.1-3.86). Type of dissemination did not influen ce the number of programme components used or the number of smoking cessati on interventions offered. Also, the estimated proportion of clients offered intervention by clinicians did not vary due to type of dissemination. A si mple mail-out of a smoking cessation programme to antenatal clinics for use during pregnancy can increase clinician intervention for smoking. When mor e intensive methods of dissemination are used, the quality of the intervent ions implemented by clinicians improves. More research on dissemination met hods are required as both methods of dissemination did not produce systemat ic or sustained use of the programme.