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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Lessons learned from the London Exercise and Pregnant (LEAP) Smokers randomised controlled trial process evaluation: Implications for the design of physical activity for smoking cessation interventions during pregnancy
Author(s): Giatras, Nikoletta
Wanninkhof, Elisabeth
Leontowitsch, Miranda
Lewis, Beth
Taylor, Adrian
Cooper, Sue
Ussher, Michael
Keywords: Process evaluation
researchers' perspective
smoking cessation
physical activity intervention
pregnant smokers
Issue Date: 17-Jan-2017
Citation: Giatras N, Wanninkhof E, Leontowitsch M, Lewis B, Taylor A, Cooper S & Ussher M (2017) Lessons learned from the London Exercise and Pregnant (LEAP) Smokers randomised controlled trial process evaluation: Implications for the design of physical activity for smoking cessation interventions during pregnancy, BMC Public Health, 17 (1), Art. No.: 85.
Abstract: Background: The challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved.  Methods: Two focus groups, with independent facilitators, were conducted with six researchers who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis.  Results: Five themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention; (2) personal characteristics of trial participants; (3) practical issues; (4) researchers' engagement with participants; (5) training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants' friends and family, and post-natal return to smoking.  Conclusions: Future exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers' friends and family, as well as for avoiding post-natal return to smoking.  Trial registration: ISRCTN48600346, date of registration: 21/07/2008
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Rights: © The Author(s). 2017 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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