Designing an educational intervention module to reduce second-hand smoke (SHS) exposure among non-smoking pregnant women [EMBARGOED]

Abstract

Pregnant women require special care and attention as second-hand smoke (SHS) exposure affects not only maternal well-being but also unborn babies. SHS exposure is associated with detrimental effects on pregnancy outcomes, including low birth weight, preterm birth, stillbirth, small for gestational age, and congenital malformations. This study aimed to develop an educational intervention module to reduce SHS exposure by examining the understanding and perceptions of pregnant women and their smoking spouses. The Analyse, Design, Develop, Implementation, and Evaluation (ADDIE) framework was used as a guide to design the intervention. The study was conducted in three phases using a sequential exploratory mixed-methods research design. Phase one consisted of a qualitative study using in-depth interviews with 24 pregnant women and their spouses to examine their understanding and perceptions of SHS exposure. In phase two, the literature review and relevant theories were integrated with the findings from the first phase to design the content of the educational intervention module. In phase three, the designed module was reviewed by experts and end-users (pregnant women and their smoking spouses) to validate the accuracy of the content and measure the module’s comprehensiveness. The findings from phase one indicated that both pregnant women and their spouses had limited knowledge of SHS exposure and some held misconceptions about strategies to reduce SHS. While pregnant women expressed how they were unable to negotiate a smoke-free home with their spouses, felt powerless, and feared disrupting their family harmony, their spouses appeared to fail to recognise their role in protecting their family from SHS exposure because of their addiction to nicotine and unbearable withdrawal symptoms during their quit attempts. The module was designed to increase their understanding of SHS exposure, empower pregnant women to create smoke-free homes and change social norms via communication skills, as well as change the smoking behaviour of spouses by increasing their knowledge of withdrawal symptoms and the availability of smoking cessation aids, thus reducing SHS exposure. The module was found to have good content validity (mean CVI = 0.99), according to the experts’ evaluation. The overall CVI validation finding from the end-user evaluation was 0.98, indicating their agreement with all aspects of the module. The newly designed educational intervention module has good content validity and could represent a breakthrough that empowers non-smoking pregnant women to protect themselves from SHS exposure and assists the spouse to change their smoking behaviour, thus encouraging smoke-free homes.