Diffusing research into routine midwifery practice

Despite awareness of the dangers of smoking in pregnancy and public health measures to prevent smoking-related disease, women continue to smoke in pregnancy. While evaluations of public health measures have found that smoking cessation interventions during pregnancy increase stopping rates, interventions are often conducted poorly or not at all. Midwives understand why women smoke in pregnancy and are aware of associated risks but they require specific knowledge and skills to support and advise pregnant women on smoking behaviour and smoking cessation. Comprehension of change processes is crucial to the implementation of new health promotion interventions. This research applied Greenhalgh et al's (2005) organisational change theoretical framework and a case study method approach to explore the process of implementing a smoking cessation intervention for pregnant women. The study was carried out according to the principles laid down in the National statement on ethical conduct in human research (National Health and Medical Research Council, 2007), produced by the National Health and Medical Research Council, Australia. Ethical approval for the research was sought and received from Queensland University of Technology human research ethics committee, prior to the start of the study. The sample constituted four participants who had been involved in the process of disseminating a training programme for midwives to implement a smoking cessation intervention. Eight semi-structured interviews were undertaken with these participants and the interviews and background programme data were subjected to theoretical analysis. The data were analysed through the lens of the Greenhalgh et al (2005) framework. The iterative analysis involved movement back and forward between framework elements to ensure a non-linear approach and to raise the conceptual level. The result was a disaggregation and (re)aggregation of data in the formation of an analytical outcome (Charmaz, 2006). The research findings demonstrated that, although there was an identified need for the intervention, limited time, capacity and lack of infrastructure support resulted in the innovation not being adopted as routine practice.