Understanding the design, implementation and adoption of postpartum smoking relapse prevention interventions: a realist review

Postpartum smoking relapse within the first year affects up to 90% of women who quit smoking during pregnancy. While a range of interventions has been developed to prevent postpartum smoking relapse, many either fail to demonstrate clear effectiveness or have only a limited impact on achieving sustained smoking cessation during this critical period. This realist review aims to enhance understanding of the design, implementation, and adoption of postpartum smoking relapse prevention interventions by developing a program theory to inform both policy and practice. We conducted a realist review using Pawson’s iterative stage approach. Three databases were searched for relevant articles. Following a realist theory-driven approach, we extracted intervention components and their associated external contexts, mechanisms, and outcomes from each study to develop the program theory. The review included 32 articles. A total of 16 intervention components were identified, along with their associated context-mechanism-outcome configurations. These intervention components were classified across three levels: the system level, the provider level, and the consumer level, including both women and their significant other. Intervention components trigger mechanisms in both providers and consumers, contributing to the outcome of preventing postpartum smoking relapse. Intervention components are embedded within external contexts, which may either facilitate or hinder their effectiveness. Postpartum smoking relapse prevention is a complex intervention, with components operating across three levels of the healthcare system. Consequently, multiple elements must be considered when designing interventions to prevent smoking relapse during the first postpartum year. This ensures that interventions address the specific needs of the target population and are well integrated into local contexts and real-world conditions.