CATCH: development of a home-based midwifery intervention to support young pregnant smokers to quit.

OBJECTIVE: to develop, implement and evaluate a supportive midwifery intervention, Community Action on Tobacco for Children's Health (CATCH), to help young pregnant smokers to quit.
DESIGN: action research project funded from April 2002 to June 2005. SETTING AND PARTICIPANTS: CATCH was based in a single hospital maternity unit in the West of Scotland and targeted a deprived population of pregnant smokers aged 25 years and under. Outreach work was undertaken in the local community and cessation support was provided in women's own homes. INTERVENTION: CATCH aimed to meet the particular needs of young pregnant women through a tailored, non-judgmental approach. The service was distinctive as it employed a holistic approach to smoking cessation which focused not only on individual choices and motivations, but on the wider life circumstances that may preclude behaviour change. MEASURES: internal and external teams collaborated to ensure a comprehensive evaluation, gathering of both process and outcome data. Outcomes (including self-reported and carbon monoxide validated quit status) were assessed by quantitative surveys undertaken at enrolment to the service and at 3- and 12-month follow-up. All those lost to follow-up were assumed to still be smoking. Participants' views of the service were gathered independently by an external evaluation team, and a detailed qualitative case study, capturing ongoing learning, was undertaken. Data were collected from participants who joined the project over a 16-month period (November 2002-February 2004).
FINDINGS: the study demonstrated a feasible approach to engaging young pregnant smokers to help them quit. Obstetricians and midwives were willing to refer to a service based in their maternity unit run by a specially trained midwife, and users reported a positive experience of the service. Of 152 eligible clients referred within the 16-month period, 79 (52%) joined CATCH. Of those who joined, 18 (22.8%) were self-reported non-smokers at 3 months, of whom 16 (20.3%) were validated as non-smokers using carbon monoxide monitoring. Thirteen (16.5%) clients reported being smoke free at 12 months, of whom 10 (12.7%) were validated as non-smokers at 12 months. IMPLICATIONS FOR PRACTICE: CATCH suggests that close partnership with the multi-disciplinary maternity team and integration into the maternity system is invaluable for smoking cessation services targeting pregnant women. It points to the benefits of the service being delivered by a trained midwife in clients' own homes. Flexibility and a non-judgmental approach are essential to engagement. Attention to the context and wider circumstances of clients' lives and involving friends and family enables clients to focus on their own smoking.