Involvement & engagement

Working to reduce the numbers of pregnant women that smoke in the North East

Natural experimental evaluation of a complex intervention to promote increased smoking cessation rates among pregnant women.

The Fuse babyClear© project demonstrates research that is translating into benefits for the public, involves collaboration, strategic partnerships, and public involvement.

What is the problem?

The numbers of women smoking in pregnancy is higher in the North East than elsewhere in England. Smoking in pregnancy has a significant impact on women’s and baby health by increasing the risk of premature births, stillbirths, miscarriages and complications after labour due to smoking.

Working in co-production with health professionals and the public

Fuse researchers worked in partnership with Fresh North East (our regional body which promotes smoking cessation), midwives and stop smoking staff to explore what might impede them from implementing best practice and identified a need for improved implementation of guidance from the National Institute for Health and Care Excellence (NICE).

Developing a solution: redesigning local services

The public involvement and consultation activities led to a redesign of NHS referral pathways developed in collaboration with a regional innovation team for pregnancy and childbirth and Fresh. This resulted in the design of babyClear©, a complex service reconfiguration intervention which is unique in the UK, to be delivered by midwives to smokers across eight NHS Trusts.

The intervention aimed to improve referral to stop smoking services and quit rates via training of midwives and stop smoking advisers, provision of carbon monoxide monitors and an enhanced ‘risk perception’ intervention (RPI).

Agreement was reached by all eight of the Foundation Trusts in the North East, plus Heads of Midwifery and Local Authority Stop Smoking Services to roll the new pathway out, starting in 2013.

Did it work? Evaluating the intervention

Funding through the SPHR Public Health Practice Evaluation Scheme (PHPES) allowed the evaluation by Fuse of the effectiveness of this bold and complex initiative. The evaluation examined the effectiveness of the pathway, looking both at numbers of women quitting smoking before delivery, but also at the impact on health indicators such as low birth weight. In addition a process evaluation examined how acceptable the intervention was with participating women smokers, but also explored in depth the service conditions which make delivery and sustainability most likely. The evaluation was conducted from April 2013 to April 2015.

A service user reference panel (SURP) was set up as part of the evaluation, consisting of women who had a baby in the last few years and were smoking at the time of conception. The purpose of SURP was to give the researchers ‘real world’ insight into the drivers of smoking behaviour during pregnancy. The SURP helped develop the content of data collection tools and identified effective recruiting methods, as well as supporting the interpretation of initial findings and contribution to dissemination activity. In addition, a consultation workshop was held with commissioners, senior managers and clinical managers of stop smoking and maternity services within the region (May 2015). This gave the researchers an opportunity to seek wider input to the work.

Early results from the evaluation show significant effect for the babyClear© intervention, both in terms of numbers of pregnant women quitting smoking during their pregnancy, but also in terms of effect on birthweight. Full results from the project should be available soon. See the links below for more information.

Contact information: Dr Ruth Bell, Clinical Senior Lecturer in Public Health, email:, Tel: +44 (0)191 208 8769.



SPHR summary

NIHR Signal



Take a look at some other examples of Fuse research activity in the NIHR School for Public Health Research.

Last modified: Fri, 15 Sep 2017 15:46:23 BST