# Tailoring a national smoking cessation support programme in co-creation with (expectant) parents in vulnerable situations

## TL;DR

This study shows how involving (expectant) parents and professionals in co-creation can improve smoking cessation support for vulnerable groups.

## Contribution

The study introduces a co-creation approach to adapt a smoking cessation program for vulnerable (expectant) parents, enhancing accessibility and personalization.

## Key findings

- Co-creation identified barriers like stress, social norms, and shame affecting engagement with smoking cessation programs.
- Participants proposed adaptations such as diverse coaching formats and involving social networks to improve program accessibility.
- The co-creation process was positively evaluated with a mean satisfaction score of 8.3/10.

## Abstract

Smoking prevalence and limited access to cessation support contribute to persistent health inequities among (expectant) parents in vulnerable situations. Co-creation may help align smoking cessation support with the lived contexts and needs of this group. This study documents and evaluates the use of co-creation to explore contextual barriers and needs, and to inform adaptations to Smoke-free Parents (SFP), a Dutch telephone-based smoking cessation programme.

Five co-creation sessions were conducted with (expectant) parents, smoking cessation counsellors, healthcare professionals, and researchers. Activities included photo-based brainstorming, peer interviews, creating fictional user profiles, and user journey mapping. Participants identified barriers to engagement with SFP and retention in SFP, brainstormed adaptations, and prioritized these. Data were thematically analysed. The co-creation process and its outputs were evaluated through interviews and a group discussion.

Three parents, two counsellors, two healthcare professionals, and two researchers participated. Identified contextual barriers included stressful life circumstances, pro-smoking social norms, shame, fear of failure, and limited discussion of smoking and cessation support with professionals. Participants highlighted the need for accessible and personalized services and involving social networks. Proposed adaptations included raising awareness of SFP among professionals and (expectant) parents, offering more diverse forms of coaching (telephone, video call, group, face-to-face), and facilitating involvement of partners or other supportive persons. Participants evaluated both the co-creation process and outcomes positively (mean satisfaction score 8.3/10).

This study illustrates how co-creation can be used to explore context and needs related to smoking cessation support among (expectant) parents in vulnerable situations, and to inform adaptations. Wider use of such co-creation approaches may support more equitable access to cessation support.

The online version contains supplementary material available at 10.1186/s12889-026-26633-9.

Socioeconomic disadvantage limits both access to and effectiveness of smoking cessation support, yet few programmes involve parents in vulnerable situations in their development, despite this being key to reducing inequalities.

This study shows how co-creation with parents, counsellors, and professionals can identify real-world contextual barriers to engaging with support and generate concrete adaptations to improve accessibility, personalisation, and social support.

These findings offer direction for policymakers and professionals on how systematic use of co-creation in smoking cessation programme development can improve reach, relevance, and equity, supporting efforts to reduce socioeconomic inequities in tobacco-related harm.

The online version contains supplementary material available at 10.1186/s12889-026-26633-9.