Behaviour change interventions to reduce second-hand smoke exposure at home in pregnant women – a systematic review and intervention appraisal


Background: Second-hand smoke (SHS) exposure during pregnancy is associated with poor pregnancy and foetal
outcomes. Theory-based behaviour change interventions (BCI) have been used successfully to change smoking
related behaviours and offer the potential to reduce exposure of SHS in pregnant women. Systematic reviews
conducted so far do not evaluate the generalisability and scalability of interventions. The objectives of this review
were to (1) report the BCIs for reduction in home exposure to SHS for pregnant women; and (2) critically appraise
intervention-reporting, generalisability, feasibility and scalability of the BCIs employed.
Methods: Standard methods following PRISMA guidelines were employed. Eight databases were searched from
2000 to 2015 in English. The studies included used BCIs on pregnant women to reduce their home SHS exposure
by targeting husbands/partners. The Workgroup for Intervention Development and Evaluation Research (WIDER)
guidelines were used to assess intervention reporting. Generalisability, feasibility and scalability were assessed
against criteria described by Bonell and Milat.
Results: Of 3479 papers identified, six studies met the inclusion criteria. These studies found that BCIs led to increased
knowledge about SHS harms, reduction or husbands quitting smoking, and increased susceptibility and change in level
of actions to reduce SHS at home. Two studies reported objective exposure measures, and one reported objective
health outcomes. The studies partially followed WIDER guidelines for reporting, and none met all generalisability,
feasibility and scalability criteria.
Conclusions: There is a dearth of literature in this area and the quality of studies reviewed was moderate to low.
The BCIs appear effective in reducing SHS, however, weak study methodology (self-reported exposure, lack of
objective outcome assessment, short follow-up, absence of control group) preclude firm conclusion. Some
components of the WIDER checklist were followed for BCI reporting, scalability and feasibility of the studies were
not described. More rigorous studies using biochemical and clinical measures for exposures and health outcomes
in varied study settings are required. Studies should report interventions in detail using WIDER checklist and
assess them for generalisability, feasibility and scalability.

Trial registration: CRD40125026666.

Keywords: Second-hand smoke, Behaviour change, Pregnancy health

View as PDF Creatve Commons logo