Biomedical subjects

Susan Pullon

Publications and source records attributed to Susan Pullon.

9 recordsLinked to original sources

PubMed2005

Can Quit Practice: a comprehensive smoking cessation programme for the general practice team.

AIMS: To develop, implement, and evaluate a programme of training and support for smoking cessation provision in general practice. METHODS: The Can Quit Practice Programme was developed for delivery in general practices with a particular focus on the skills of the practice nurse (PN) in providing quit support. The Programme utilises the principles of brief intervention by the GP or PN followed by a systematic quit support programme delivered by trained practice nurses (quit advisors). Alternative implementation strategies and the provision of ongoing support and problem solving sessions were integral parts of the Programme. The evaluation used qualitative and quantitative methods to establish quit rates for participants enrolled in the Programme and explore the efficacy of programme delivery. RESULTS: The quit rates achieved by 85 smokers (from 14 general practices) enrolled in the Can Quit Practice Programme evaluation were; 25.9% at 3 months; 22.4% at 6 months; and 20.0% at 9 months. Important components of successful implementation were: an autonomous role for PNs; well-managed practice procedures; adequate consultation time; and adequate funding for health promotion. CONCLUSION: Smoking cessation programmes can be successfully implemented and maintained within general practices as an integrated part of primary healthcare.

Family Practice↗

PubMed2005

"What sort of health promotion are you talking about?": a discourse analysis of the talk of general practitioners.

In New Zealand, health promotion is now expected to be an integral part of the work of a general practitioner, and in the recently implemented New Zealand Primary Health Organisation structure, specific funding is available to undertake health promotion activities in primary care. Eighteen general practitioners recruited to take part in two focus groups discussing men's health, talked extensively about health promotion. This talk was analysed through a discourse analysis. This study of the 'talk' of general practitioners suggests that there are problems in transferring the concept, which must be recognised and addressed if health promotion is going to be taken up effectively within general practice. The meaning given to health promotion in the consultation is unclear and general practitioners were unsure about its value in 'health checks' and screening. Lack of time and lack of confidence in the evidence appeared to be barriers to undertaking health promotion within general practice consultations. In the current climate general practitioners are uncertain, to the point of ambivalence, about health promotion in their work. Further work will be required to ensure this ambivalence does not result in covert resistance.

Adult↗

PubMed2004

Can support and education for smoking cessation and reduction be provided effectively by midwives within primary maternity care?

OBJECTIVE: To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care, can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding. DESIGN, SETTING AND PARTICIPANTS: In a cluster randomised trial of smoking education and breast-feeding interventions in the lower North Island, New Zealand, midwives were stratified by locality and randomly allocated into a control group and three intervention groups. The control group provided usual care. Midwives in the intervention groups delivered either a programme of education and support for smoking cessation or reduction, a programme of education and support for breast feeding or both programmes. Sixty-one midwives recruited a total of 297 women. INTERVENTIONS: Structured programmes provided by midwives. FINDINGS: Women receiving only the smoking cessation or reduction programme were significantly more likely to have reduced, stopped smoking or maintained smoking changes than women in the control group, at 28 weeks and 36 weeks gestation. Women receiving both the smoking cessation and breast-feeding education and support programmes were significantly more likely than women in the control group to have changed their smoking behaviour at 36 weeks gestation. There was no difference in rates of cessation or reduction between the groups in the postnatal period. There was no difference in rates of full breast feeding between the control and intervention groups for women who planned to breast feed. KEY CONCLUSIONS: Education and support by midwives, as part of primary midwifery, can facilitate smoking cessation and reduction during pregnancy.

Breast Feeding↗

PubMed2003

Factors that influence changes in smoking behaviour during pregnancy.

AIMS: This study explored characteristics of women who continue to smoke beyond the first trimester of pregnancy. METHODS: A cohort of 1283 pregnant women were surveyed at the time they registered with a maternity care provider, using a postal questionnaire. Women who reported they were ex-smokers were asked when they had stopped smoking. Data were analysed using logistic regression to identify socio-demographic variables associated with smoking and with stopping smoking. RESULTS: 829 (69.2%) women responded to the questionnaire. 183 (22.2%) reported smoking when they became pregnant. Forty nine (26.8%) of the women smoking at conception reported giving up in the first trimester. Factors significantly associated with stopping smoking in the first trimester were current employment (OR 2.37, 95% CI 1.16-4.85), first pregnancy (OR 2.18, 95% CI 1.11-4.28), and experiencing nausea during the pregnancy (OR 2.59, 95% CI 1.11-6.04). Women who held a community services card (OR 0.41, 95% CI 0.19-0.86), Maori women (OR 0.38, 95% CI 0.15-0.98) and women whose partners smoked (OR 0.35, 95% CI 0.17-0.70) were significantly less likely to have stopped smoking. CONCLUSION: Socioeconomically deprived women were more likely to continue to smoke beyond the first trimester of pregnancy and this needs to be taken into account in the provision of smoking cessation support.

Cohort Studies↗

PubMed2003

The midwife's role in facilitating smoking behaviour change during pregnancy.

OBJECTIVE: To explore the midwife's role in providing education and support for changes in smoking behaviour during usual primary maternity care. DESIGN: A qualitative study using a thematic approach to analysis of data collected in face-to-face interviews. SETTING AND PARTICIPANTS: Eleven women who had participated in the intervention groups of the MEWS Study, a cluster randomised trial of education and support for women who smoke, and 16 midwives from the intervention and control arms of the trial. The trial was set in the lower North Island of New Zealand in 2000. FINDINGS: Midwives acknowledged that asking women about smoking was part of their role as maternity care providers. However, many found it difficult to know how to ask women about their smoking, how to identify the women who would be receptive to advice and how to support them to make changes to their smoking. Midwives were also concerned about making women feel guiltier than they already did about their smoking, and about the impact of providing smoking cessation on their relationship with women. In contrast, women expected their midwife to ask them about their smoking. When women wanted to quit their midwife was an extremely valuable source of information and support. Midwives were also in a position to help women who did not want to quit to make other changes to their smoking behaviour. Even women who did not want to quit were prepared to be asked about their smoking. Problems arose when the way the midwife asked and the frequency of her enquiries were not appropriate for the stage of the change cycle the woman was in. IMPLICATIONS FOR PRACTICE: Midwives can effectively provide education and support for smoking change during pregnancy if they match the woman's readiness to make changes with the type of advice and support they provide.

Adult↗

PubMed2003

Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy.

This study describes the development and evaluation of education programmes and associated resource materials to support smoking cessation and reduction, and breastfeeding promotion strategies for pregnant women who smoke, during usual primary maternity care by midwives. Education programmes and resource materials were developed by midwives and researchers as part of a cluster randomized trial of Midwifery Education for Women who Smoke (the MEWS study). Development included a cohort study, advice from lactation consultants and smoking cessation counsellors (including Ma-ori professionals), and early consultation with midwives who would be delivering the programmes. Resources developed included videotapes, charts and laminated information cards. Resources were pre-tested with pregnant women and opinion leaders. Consultation with the midwives allocated to each of the intervention groups in the trial raised a number of issues. These were addressed, and solutions incorporated into each of the programmes, to enable effective delivery within usual care. Following delivery of the programmes, women and their midwives were surveyed and a sample interviewed to ascertain attitudes to the programmes and resources. Women and their midwives responded positively to the smoking cessation education programme, the breastfeeding promotion programme and the resources used. Those women who did not stop smoking completely often succeeded in significantly reducing their tobacco consumption. Women identified their midwife as a valuable resource and appreciated her ongoing encouragement. Involvement of health professionals who are to deliver health promotion interventions is essential for successful integration of programmes into usual care. Midwives were able to effectively deliver programmes that were developed and targeted to their needs as health educators. The pregnancy-specific resources developed for women who smoke played an important part in helping midwives deliver their health promotion messages more effectively.

Adult↗

PubMed2002

Factors influencing alcohol consumption during pregnancy and after giving birth.

AIMS: This study explored the demographic profile of women consuming alcohol during pregnancy and after giving birth, as part of a larger cohort study of smoking during pregnancy. METHODS: This was a prospective study of a cohort of 665 women registered with a maternity care provider organisation for antenatal care in Wellington. Data were collected from postal questionnaires sent at intervals during gestation and the postnatal period. The questionnaires elicited information about smoking, alcohol consumption and demographic data. RESULTS: At 24 weeks gestation, 74% of women reported not consuming any alcohol in the preceding seven days. Women who were pregnant for the first time, women who experienced nausea, women who were socio-economically deprived and women who smoked were less likely to report having consumed alcohol. At six weeks after giving birth the number of women reporting not consuming any alcohol in the preceding seven days decreased to 46%. Socio-economic deprivation was associated with abstention and tertiary education with alcohol consumption. CONCLUSIONS: Approximately a quarter of women continue to drink alcohol during pregnancy. Health education aiming to reduce alcohol consumption in pregnancy needs to take into account the profile of women who drink during pregnancy.

Adult↗

PubMed2002

Factors influencing continuation of breastfeeding in a cohort of women.

The objective of this study was to prospectively explore the influence of women's experiences in preparing for and establishing breastfeeding on the duration of breastfeeding. A cohort of 490 women was surveyed at intervals during pregnancy and after giving birth. Data were collected on breastfeeding outcomes and experiences and analyzed using multiple logistic regression. After controlling for sociodemographic variables, women were less likely to be still fully breastfeeding at 6 to 10 weeks postpartum if they believed they needed more breastfeeding information prior to delivery or had experienced breastfeeding problems. Women were less likely to be fully breastfeeding at 4 months postpartum if they had experienced breastfeeding problems. This prospective study demonstrated the influence of women's preparedness for breastfeeding and their experiences in establishing breastfeeding on breastfeeding duration. Improvements in prenatal education about breastfeeding and management of breastfeeding problems are likely to increase breastfeeding duration.

Breast Feeding↗

PubMedDate not supplied

Smoking cessation and nicotine replacement therapy in current primary maternity care.

AIM: To determine attitudes, activity and confidence among general practitioners and midwives about smoking cessation practice, and use of nicotine replacement therapy (NRT) during pregnancy and breastfeeding. METHOD: A postal survey of 780 New Zealand health professionals providing maternity care. RESULTS: 274 GPs (82 practising obstetrics) and 184 midwives responded (RR: 64%), with most (88% GPs, 77% midwives) regarding providing smoking cessation advice integral to their job. Only about half gave smoking cessation advice to most pregnant women who smoked. They were uncertain about the safety of NRT use in pregnant and breastfeeding women. Most respondents requested more information about NRT use. DISCUSSION: Smoking cessation practice falls short of respondents' beliefs about good practice and current recommendations.

Attitude of Health Personnel↗