Healthcare professionals’ experiences of supporting pregnant women with mental illness with their smoking behaviours: A qualitative study

Introduction
Pregnant women who use specialist perinatal mental health services are more likely to be smokers at the time of birth than those without mental illness. This study explored health professionals’ experiences of providing smoking cessation support to pregnant women with complex and severe mental illness.

Methods
Online video semi-structured interviews were conducted in England October 2023 – October 2024 with 20 National Health Service (NHS) healthcare professionals whose role included discussing smoking cessation with pregnant women with mental illness. Using job descriptions, participants were categorised ‘signposters’ (n= 11) or ‘stop smoking practitioners (SSP)’ (n=9). Interview topic guides and data analysis were guided by the Theoretical Domains Framework.

Results
Reported barriers to effective provision of smoking cessation support included prioritising mental health over smoking cessation and being cautious about communicating harms of smoking in case it caused women’s mental health to deteriorate. Health professionals also lacked confidence that pregnant women with mental illness could quit. Lacking knowledge about the relationship between mental health and smoking was a barrier specifically for many ‘signposters’. Facilitators included having capacity for health professionals to be responsive to women’s needs, offering flexibility and effective integration of smoking cessation services within maternity and mental health care settings.

Conclusions
Barriers to effective smoking cessation support included prioritising mental illness over smoking cessation advice and a pessimistic view that pregnant women with mental illness would struggle to quit smoking. Facilitators included full integration of services and adapting to women's needs by offering flexible timing and delivery of smoking cessation support.

Implications
This study shows multiple areas which may be impacting on the effectiveness of smoking cessation support available to pregnant women with mental illness. Future research could address some of the barriers identified in the study including prioritising mental health over smoking cessation, addressing health professionals’ beliefs that pregnant women with mental illness are unlikely to quit smoking, training on communicating harms of smoking and improving knowledge on effect of smoking on mental health. Future research could also focus on sharing good practice including appointment flexibility and full integration of smoking cessation services within maternity and perinatal mental health services.