Designing behavioural change intervention module for tobacco cessation counselling among pregnant tobacco users in India: a methodology paper

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Tobacco use has detrimental effects on women's reproductive health and is associated with poor pregnancy outcomes. Antenatal care (ANC) check-ups provide health professionals with a unique opportunity to screen and counsel pregnant tobacco users to quit. Currently, in India, pregnant women are not being screened for tobacco use during antenatal care visits and healthcare providers lack formal training to provide tobacco cessation advice. This article describes the designing and development of a tailored behaviour change intervention (BCI) module for tobacco cessation and its delivery to pregnant women attending antenatal clinics. The BCI module was designed to incorporate the components of the Capability, Opportunity and Motivation Model and the Behaviour Change Wheel guide. The development was done in three steps-understanding the behaviour, developing intervention model, and identifying implementation options along with monitoring and evaluation strategies. The module has three tools-counselling flipbook for healthcare provider, take home pamphlets, and information posters for patient waiting areas. A gender- and culture-specific BCI module was developed and implemented to screen and counsel 105 pregnant tobacco users during antenatal visits, leading to high self-reported tobacco quit rate (69%) which corroborated with urine cotinine levels at baseline and end line.