Barriers and enablers to implementation of antenatal smoking cessation guidelines in general practice.

Smoking is a major preventable cause of adverse outcomes in pregnancy. Despite the existence of smoking cessation support guidelines, many pregnant smokers do not receive support in quitting. The aim of this study was to identify and understand the facilitators and barriers experienced by GPs in implementing the 5As of smoking cessation support with pregnant women. The results of this study may help in shaping interventions to support GPs in implementing the guidelines. This was a qualitative study using semi-structured interviews built around the Theoretical Domains Framework. Participants were 15 GPs, and thematic analysis was used to identify relevant themes. Perceived barriers to implementing guidelines included unfamiliarity with the 5As, uncertainty using nicotine replacement therapy, lack of time, and fears of damaging rapport. Perceived facilitators included high levels of knowledge and skills, patients' expectations and a recognition that smoking cessation was a fundamental and essential part of the GPs' role in antenatal care. Educating and training GPs regarding the 5As and NRT (nicotine replacement therapy) use in pregnancy may have a role in improving delivery of smoking cessation support. The strong overall commitment to provision of smoking cessation support among GPs may also have a role in developing interventions in the future.