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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Smoking During Pregnancy.

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Strategy. Feedback (Pregnancy)

Approach. Provide feedback to support reduction for smoking cessation behaviors

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Overview. Research indicates that using feedback incorporated into comprehensive smoking cessation interventions can enhance the reduction of smoking during pregnancy.[1] Feedback interventions are those where a pregnant woman is provided information about the fetal health status for the results of measurement of tobacco smoking by-products to initiate for reinforce smoking cessation behaviors. This information for measurement includes ultrasound monitoring, and carbon monoxide for urine cotinine measurements, with the results shared at points in time with the pregnant woman.[2,3]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Tracking data on feedback delivery and content
  • Participant engagement data with feedback
  • Survey data on short-term behavioral responses to feedback

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Consultation (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of prenatal care providers trained in delivering feedback interventions for smoking cessation. (Measures provider capacity building)
  • Number of ultrasound for biochemical feedback sessions conducted with pregnant women who smoke. (Measures intervention delivery)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of feedback sessions where the provider used motivational interviewing techniques. (Measures quality of intervention delivery)
  • Percent of feedback visuals and messages tested for comprehension with the focus population. (Measures tailoring of materials)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of ob-gyn practices with a workflow to refer individuals who smoke to quitline services after feedback. (Measures systems-level integration)
  • Number of community health workers trained to reinforce feedback messages during home visits. (Measures community-based support)
  • Number of individuals who make a smoking quit plan after receiving concerning feedback results. (Measures action planning)
  • Number of pregnant women with improved birth outcomes relative to prior pregnancies with no feedback. (Measures long-term health impact)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of pregnant Medicaid beneficiaries who receive smoking feedback interventions. (Measures impact of access to intervention)
  • Percent of feedback sessions delivered in community settings vs. clinical sites in various areas. (Measures community-based delivery)
  • Percent of pregnant women who smoke expressing stronger motivation to quit after receiving feedback. (Measures impact on quit motivation)
  • Percent of individuals who say the feedback increased their confidence in quitting ability. (Measures impact on self-efficacy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Chamberlain C, O-Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art No.: CD001055. https://doi.org/10.1002/14651858.CD001055.pub5.

2 Morgan H, Treasure E, Tabib M, Johnston M, Dunkley C, Ritchie D, Semple S, Turner S. An interview study of pregnant women who were provided with indoor air quality measurements of second hand smoke to help them quit smoking. BioMed Central Pregnancy Childbirth 2016 Oct 12;16(1):305.

3 Harris M, Reynolds B. A pilot study of home-based smoking cessation programs for rural, Appalachian, pregnant smokers. Journal of Obstetric, Gynecologic, & Neonatal Nursing: Clinical Scholarship for the Care of Women, Childbearing Families, & Newborns 2015;44:236-45.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.