Implementation of the 'Fresh Start' smoking cessation programme to 23 antenatal clinics: a randomized controlled trial investigating two methods of dissemination

The aim of the research was to investigate the effect of two methods of dissemination on the implementation of a smoking cessation programme and use of smoking cessation interventions in antenatal clinics. A repeated-measures randomized design was used. Hospital antenatal clinics (n = 23) were randomized to simple or intensive dissemination groups. All clinics in NSW with > 500 births were asked to participate. A survey of all clinical staff (n = 323) in 23 antenatal clinics was carried out prior to programme dissemination and 18 months after dissemination (n = 283). The response rate was 63% at baseline and 64% at follow-up. Smoking cessation intervention significantly increased after dissemination. (F (18,1) = 49.26, p < 0.001). The average number of smoking cessation interventions provided by clinics after programme dissemination increased from 4.5 to 7.48 (mean difference 2.98, t( 19) 7.08, n < 0.001, 95% CI (2.1-3.86). Type of dissemination did not influence the number of programme components used or the number of smoking cessation interventions offered. Also, the estimated proportion of clients offered intervention by clinicians did not vary due to type of dissemination. A simple mail-out of a smoking cessation programme to antenatal clinics for use during pregnancy can increase clinician intervention for smoking. When more intensive methods of dissemination are used, the quality of the interventions implemented by clinicians improves. More research on dissemination methods are required as both methods of dissemination did not produce systematic or sustained use of the programme.