2. Materials and Methods
2.2. Procedure and Participants
2.3. Ethical Considerations
3.1. Views on Implementation of the Pathway
3.1.1. Perceived Impact on Professional Roles
“Just the fact that they keep giving us more jobs here. We get more and more jobs. We haven’t got enough time to actually do all the jobs.”(p. 5, HSW, Before)
“To begin with there was a lot more (referrals) than there is now. It gave us quite a big workload, but we’ve worked through it, there’s SOPs (standard operating procedures) on what we should do and how it’s to be done and as soon as that was put in to place it was a hell of a lot easier to do.”(p. 10, SSS, After)
“I think the difficulty was that with many of our other referrals people are choosing to refer themselves and they’re fully aware of exactly what they’re being referred in to. That was the difficulty with these women. So I guess in that sense they didn’t always get the same as that other referral, because they didn’t know why we were calling them. And that’s why sometimes it took a lot more work.”(p. 7, SSS, After)
3.1.2. Confidence in Administering the Pathway
“I think that’s how they might see it, some of them, that you’re either being patronizing or you’re accusing them of smoking when they don’t, which I’m not going to be doing either, I’m just going to be asking a question for their wellbeing, it’s not my wellbeing, it’s their we’re concerned with.”(p. 2, HSW, Before)
“I feel a bit bad because I’ll know my next question from them is ‘well why is there (high CO reading) and what does it mean and what’s going to happen’, and I’ll have to say ‘I’m sorry, look I don’t know!’”(p. 2, HSW, After)
“Yeah it’s a really difficult number (4–7 ppm), because obviously it is triggering a referral, but we just didn’t know why (…) so I tried to find some research about that, but there’s nothing out there. Nobody got back to me. I rang [the CO monitor manufacturer] as well and tried to get information from them as to why we might get false readings.”(p. 7, SSS, After)
3.1.3. Engaging the Women
“We don’t ask them, we tell them that this is a test we’re going to do. I don’t actually ask, but then when I’ve told them what test we’re going to do, I do say ‘is that alright’ and most of them just say ‘yes’ , but a few have refused.”(p. 5, HSW, After)
3.2. Impact of the “Opt-Out” Referral Pathway on the Women
3.2.1. Impact on Non-Smokers with CO Levels ≥ 4 ppm
3.2.2. Impact on Smokers Not Ready to Quit
“I suppose it’s difficult sometimes because there’s women that smoke and have had babies that are perfectly well, so it’s hard to get through to somebody that’s seen that, because they can turn round and say ‘well, my sister’s just had a baby and she smokes and her baby’s absolutely fine, so why should I stop smoking’…But I suppose some people don’t understand the complications as much, so I suppose they should have the options there, that this could happen and that could happen.”(p. 4, HSW, Before)
“I think ‘the ‘opt-out’ pathway’ is just something else that contributes to that drip, drip, drip effect…It may be that they continue to smoke for that pregnancy, but for the next pregnancy they think about it and they’ve quit. You know it’s really hard to measure…”(p. 8, SSS, After)
3.2.3. Impact on Smokers Ready to Make a Positive Change
“With the CO reading we get a lot of clients who say that they are going to face-to-face appointments because we can see the CO reading and they can see how it’s affecting them internally as well as, you know, externally really…because it kind of is a shocker I think to some people.”(p. 9, SSS, After)
Conflicts of Interest
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