Abstract â–¡ 20

Motivational interviewing was developed in the addictions field for helping people work through ambivalence about behaviour change. This project uses methods of self-initiated and professionally facilitated change of addictive behaviours using the key transtheoretical constructs of stages and processes of change. The methods are based upon the use of a menu of strategies, to match the client's degree of readiness to change. Modification of addictive behaviours involves progression through six stages:-pre-contemplation, contemplation, preparation, action, maintenance and relapse. Between February 1997 and January 1998 a pilot randomised controlled experiment was performed to assess the acceptability of home-based motivational counseling by a specially trained midwife, in helping pregnant smokers reduced their habit. One hundred women consented and completed a questionnaire on smoking habit, support and position on the 'cycle of change'. Fifty were allocated to receive normal care plus 3-6 home visits (intervention) and fifty normal care (control). Residual blood samples for cotinine estimation from 95/100 at booking and 100/100 at 32-36 weeks gestation were matched with self-reports of smoking habits, and position on the 'cycle of change'. Postnatal focus groups of community midwives and clients documented professional/client satisfaction. All home interviews were audio-taped, transcribed, and analysed to document the process of motivational interviewing performed. A full randomised controlled trial to assess the efficacy of midwife motivational counselling will be performed in 1999/2000. This paper describes the structure and process of this pilot smoke-change study.