Primary care interventions to reduce secondhand smoke exposure: a mixed methods systematic review and synthesis

Problem

Secondhand smoke exposure (SHSe) continues to increase the mortality and morbidity of non-smokers. Healthcare professionals (HCPs) based in primary care settings are likely to provide services to patients at risk of secondhand smoke (SHS) or who regularly smoke around others. Currently, it is unclear how SHSe is addressed in primary care environments. A segregated mixed-methods systematic review and synthesis was conducted to explore the current knowledge, attitudes and practices of primary care HCPs regarding SHSe.

Approach

Existing literature was searched for evidence on: (i) what primary care HCPs know and understand about SHS; (ii) how primary care HCPs’ currently practice to promote SHSe reduction (iii) primary care HCPs’ beliefs and experiences of delivering of interventions to reduce SHSe (iv) which factors influence the delivery of SHS-related interventions in primary care. Six electronic databases were searched for relevant articles published between January 1980 and February 2016. The quantitative and qualitative data were independently synthesised. A Bayesian approach was then used to synthesise these results; involving the application of qualitative thematic descriptions to the quantitative data to allow for meta-aggregation of the individual syntheses.

Findings

17 quantitative and 3 qualitative full-text articles were included in the review. Primary care HCPs have a basic understanding of the risks associated with SHSe but they require training to help them intervene around SHSe in practice. Reported practices vary and were determined by the attitudes of the HCP regarding SHSe; attitudes were either ‘passive’, ‘advisory’ or ‘judgemental’. Practices involving asking about SHSe or providing advice were more commonly reported and documented than practices involving actions to facilitate the reduction of SHSe. All actions were specific to cessation promotion; none concerned SHS harm reduction. SHSe was viewed as an issue of high importance and relevant to the primary care HCP’s role. However, barriers such as level of priority given to the issue of SHSe and the desire to protect the professional relationship with smoking parents, prevented HCPs from intervening around SHSe.

Consequences

This is one of the first mixed-methods systematic review and syntheses to explore primary care HCPs’ knowledge, attitudes and practices around SHSe. The results show a clear need to provide further support to HCPs in primary care to enable them to reduce SHSe in practice. Our work highlights a lack of evidence around harm reduction approaches to reducing SHSe. The potential to deliver harm reduction messages in primary care should be explored. Future research should explore the development of interventions from the perspectives of both practising HCPs and of patients in order to minimise the effects of barriers to implementation.