Mapping social networks to support smoking cessation in pregnancy

1
Mapping social networks to support smoking
cessation in pregnancy

• Fiona Dobbie, Lesley Sinclair,
• School of Heath Sciences and Sport, University of
  Stirling
• Andrew Radley, NHS Tayside

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Content

• Background
• Aim
• Study design
• Key findings orientation phase
• Intervention design
• Feedback on proposed intervention
• Next steps

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The problem

• Smoking  in pregnancy is a harmful for both
  mother and child
• Rates of smoking in pregnancy remain high
  particularly in communities with high levels of
  social disadvantage
• 29 of pregnant women living in the most deprived
  areas of Scotland were current smokers in
  comparison with 4.5 living in least deprived
  area. (Information Service Division Scotland,
  2015)
• UK Stop Smoking Services support pregnant women
  to quit.
• But, outcomes are poor with only a small
  proportion of pregnant women who smoke make use
  of existing services more innovative approaches
  required (NICE, 2010)

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Social Networks and Health

• Our embeddedness in social networks affect our
  health and behavioural choices (Perkins et al
  2015, Hunter et al, 2015)
• Attitude and smoking behaviour of partners,
  family and friends have been identified as
  barriers to cessation (Hiscock et al 2011, Prady
  et al 2011).
• Studies have shown that reducing the number of
  smoking friends in a network can help quit
  attempts (Hitchman, et al, 2014)
• Lorencatto et al (2012) emphasised the importance
  of social support BCTs to aid smoking cessation
  in pregnancy
• Yet, few examples of how this link can be
  applied.

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Study aim

• To design an intervention to support pregnant
  women living in deprived areas stop smoking using
  social support from their social networks.

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Study design

• Three phases to the study
• Orientation identifying the evidence base,
  existing theory, clarifying scope and purpose
• Intervention design
• Feedback on proposed intervention

7
Study design

• Rapid literature review
• identity theory and possible models/components of
  the intervention
• Co-creation approach consultation with
• pregnant women (n7)
• members of their social networks (n8)
• academics working in social network research and
  smoking cessation
• Service providers in NHS, Local Authority, and
  pharmacy staff working in smoking cessation /
  tobacco control (workshop n25)

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Key findings orientation phase
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Rapid literature review

• Searched for studies using the social network of
  pregnant women to facilitate any type of HBC
  during pregnancy and up to 6 weeks postpartum
• All type of study design included
• Limits
• social network defined as friends and family
  only, not professionals
• Articles written in English from 2000 onwards

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Summary of paper search and selection process
for rapid review
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Literature review

• Six studies identified where social network
  members provided social support.
• But, long term efficacy was poor and none of them
  mapped the social network to identify sources of
  support.
• This highlights an important gap in social
  network health behaviour change theory.
• Focus was to identify someone from the social
  network to offer social support, not how and why
  they were the most relevant person.

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Literature review - existing theory

• Who should provide what to whom and when?
  (Heaney and Israel, 2008)
• who friends and family
• what social support to stop smoking
• whom pregnant women trying to stop smoking
• when during pregnancy and three months post
  partum
• how - ?
• To measure effectiveness and access the target
  group intervention need to be delivered by
  service providers working with pregnant women
  (e.g. midwives, health visitors, pharmacists,
  smoking cessation advisors).

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Literature review - existing theory

• Heaney and Israel (2008) 5 typologies
• Enhancing existing network ties
• Developing new social network linkage
• Enhancing networks through the use of natural
  helpers and community health workers
• Enhancing networks through community building and
  problem solving
• Combing strategies

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Literature review - existing theory

• Valentes (2012) taxonomy of SN interventions
• identify individuals to promote behaviour change
• segmentation identifying groups (cliques) who
  are targets for the intervention
• Induction cascading of information e.g. word of
  mouth, also used as recruitment tool
• Alteration seeks to alter the network to change
  behaviour by adding or deleting nodes

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Literature review

• Useful but requires mapping and analysis of
  social networks - ambitious and resource
  intensive for service providers
• Raised our interest in network visualisation
  tools (such as concentric circles) and potential
  hypothesis
• If pregnant women mapped their network and had a
  better understanding of network structure and
  resources within it would this influence who they
  picked to offer social support and how would this
  affect their smoking cessation attempt?

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Intervention design
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Concentric circles

• Respondent name in centre
• Add names of people they feel close to on post it
  notes
• Circles indicate level of closeness
• Add detail on
• Relationship to them
• Age
• Employment status
• Smoker or non-smoker
• Frequency of contact

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Concentric circles

• Coloured dots added to identify
• Who is/has helped them try to quit (yellow dot)
• Anyone who is making difficult /made it difficult
  to quit? (red dot)
• Anyone who they would like / would have liked to
  help them quit but didnt? (blue dot)

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Concentric circles

• Maps then used as a tool to enable pregnant women
  to reflect on
• Strong and weak sources of support
• The type of support they receive
• Identify ways they can optimise support from
  their social network
• Strategies to manage non supportive members of
  their social network

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Feedback on proposed intervention
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Feedback from interviews with PW (N7)

• Support for the idea
• Good to visually see network and think about
  sources of support
• Triggered new insights and ideas
• Liked the visual aspect something they could
  refer back to and update
• Easy to complete and did not take long (around 5
  minutes depending on network size)

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Feedback from interviews

• Points to consider
• Network size varied, common to consist of family
  members with few friends
• Lack of awareness of how social networks could
  support them - self reliance and will power
  common approach (one respondent added no dots)
• Practicalities of completing the map language
  and literacy barriers

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Feedback from practitioners

• Potential to consolidate existing practice
• Gives women insight and lets them make informed
  choices on network support
• Can be used for other health behaviour change
• But
• Where does it fit? Who will administer it?
• How often would it be used/revisited?
• How do you measure impact? (realistic
  expectations)
• Success dependant on confidence of women to
  engage with her network, but also who delivers it
  (need staff buy in)

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Next steps
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Progress to date
Feasibility/Piloting 2017-2020 Pilot 3-arm
randomised controlled trial process evaluation
to assess feasibility and acceptability
Evaluation 1. Assessing effectiveness 2.
Understanding change process 3. Assessing
cost-effectiveness
Development 2014-2016 Develop and co-produce
intervention theory, website, mobile app, user
manual and training resources.
Implementation 1. Dissemination 2. Surveillance
and monitoring 3. Long term follow-up
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Research team advisory group

• funded by CRUK/BUPA innovation award

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Thank you

• Fiona Dobbie
• fiona.dobbie_at_stir.ac.uk