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Promoting smoking cessation during pregnancy

A combined feasibility and pilot trial of a theory-based intervention using narrative, images and embedded behaviour change techniques, delivered via text messaging


The SKIP-IT project plans to investigate the feasibility and likelihood of success of a narrative and image-based intervention for smoking cessation in pregnant women. Recruitment methods, the feasibility of delivering the intervention, retention and follow-up processes will be assessed for potential continuation to a full-scale (Phase III) multicentre randomised controlled trial.


Smoking during pregnancy carries serious risks to mother and infant health. Smoking is strongly related to health inequality, more people in the lower socioeconomic groups smoke. Around half of smokers quit during pregnancy but relapse rates are high and many continue to smoke in particular in areas of high deprivation. In Scotland 17% of women were recorded as smokers at the first antenatal appointment; with rates as high as 38% in pregnant women under 20 years of age. Better smoking cessation interventions are urgently required to reduce the number of preventable stillbirths and neonatal deaths and improve the health of mothers and infants.

We have developed, and carried out initial testing of a theoretically and empirically informed intervention aimed at supporting smoking cessation in pregnant women. Findings informed the development of a novel, narrative, story-telling intervention delivered via automated text messages. It aims to alter women’s perceptions of risk, social norms, outcomes and self-efficacy using three key elements: 1) a narrative story of a fictional young pregnant woman ‘Megan’ trying to stop smoking by overcoming a series of commonplace barriers, 2) images showing the size of their fetus and its stage of development 3) a ‘help’ function to receive smoking cessation advice.

To achieve sustained smoking cessation through and after pregnancy women will need to engage with the intervention over an extended period of around nine months, this will require a high degree of appeal. We are therefore conducting a study in two phases to extend the intervention, develop recruitment strategies and to assess the likelihood of the intervention being effective.

Principal Investigator: Professor Helen Cheyne

NMAHP Research Unit Collaborators: Andrew Elders

External Collaborators: Abhyankar P - University of Stirling, Bauld L - University of Stirling, Gardiner C - NHS Health Scotland, Jones C - University of Dundee, O'Carroll R - University of Stirling,  Steele M - University of Southampton, Williams B - Napier University Edinburgh, Winton M - NHS Tayside.

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