Optimisation of Baby, Me & NRT: a nicotine replacement therapy adherence intervention for pregnancy

OBJECTIVE: Nicotine Replacement Therapy (NRT) is effective for quitting smoking, but pregnant women appear to benefit less than others. Likely reasons include poor adherence due to erroneous beliefs about NRT. We developed a theory-guided, blended interpersonal and digital NRT adherence intervention ('Baby, Me & NRT' [BMN]) for delivery alongside standard UK pregnancy smoking cessation care. Aims were to optimise BMN's acceptability and feasibility of delivery prior to efficacy evaluation. METHODS: Three sequential cohorts of pregnant daily smokers received standard care plus BMN from pre-quit to 28 days after quit date, with subsequent qualitative and quantitative data collection. Data analysis utilised the Person-Based Approach 'table of changes' method, with refinements after each cohort. RESULTS: = 23) attended all six consultations. Twenty-five (71%) participants, and their practitioners, provided feedback. Improvements included: using an NRT beliefs questionnaire to guide counselling; recommending NRT patches overnight if needed; making texts responsive to recipients' smoking and NRT use; allowing recipients to reduce text frequency; adding a webpage featuring real-life pregnancy quit stories; adapting leaflet images to more clearly convey messages. CONCLUSION: successive cohort testing and appears feasible to deliver.