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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. Health Care Provider Training (Pregnancy)

Approach. Train health care providers to promote prenatal smoking reduction and cessation

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Overview. Research indicates that pregnancy is a motivating time that affords a teaching opportunity to help women engage in healthy lifestyle modification. Health care providers, such as midwives, nurses, and maternity staff, can serve as key promoters of prenatal smoking reduction exposure as part of their professional role in health promotion and education. These health care providers can be educated and trained to use evidence-based counseling techniques, such as the 5 A’s, to improve referral and treatment access for pregnant women who smoke.[1,2]

Evidence. Moderate Evidence. Strategies with this rating are likely 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:

  • Evaluation data
  • Changes in provider knowledge, attitudes, and self-efficacy
  • Survey data on provider practices and implementation of training content

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.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-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 healthcare providers completing training on smoking cessation counseling techniques. (Measures workforce capacity building)
  • Number of prenatal care sites hosting on-site training for their staff on the 5A's. (Measures organizational commitment to training)

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

  • Percent of provider training sessions led by a certified tobacco treatment specialist. (Measures quality of training delivery)
  • Percent of providers scoring at least 90% on post-training assessments of 5A's knowledge and skills. (Measures training effectiveness)

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

  • Number of regional perinatal quality collaboratives that adopt the provider training curriculum. (Measures spread of training program)
  • Number of provider training completers who become cessation champions within their care teams. (Measures development of internal supporters)
  • Number of pregnant women who report receiving advice to quit from multiple trained providers during prenatal care. (Measures consistency of messaging)
  • Number of individuals who quit smoking during pregnancy after receiving 5A's counseling from a trained provider. (Measures ultimate behavior change)

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

  • Percent of trained providers practicing in communities with high rates of smoking during pregnancy. (Measures distribution of trained providers)
  • Percent of regional perinatal quality collaboratives that adopt the provider training curriculum. (Measures spread of training program)
  • Percent decrease in the gap in timely cessation treatment access between rural and urban pregnant women who smoke. (Measures geographic impact)
  • Percent of pregnant women who accept a referral to smoking cessation treatment from a trained provider. (Measures impact on treatment engagement)

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 Chertok IRA, Archer SH. Evaluation of a midwife- and nurse-delivered 5 A's prenatal smoking cessation program. Journal of Midwifery & Womens Health 2015;60:175-81.

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.