Primary care interventions to help reduce secondhand smoke exposure: a cross-sectional survey of UK healthcare professionals

Problem

Secondhand smoke exposure (SHSe) remains a significant public health issue and is associated with increased mortality and morbidity for non-smokers. Healthcare practitioners (HCPs) based in primary and community care settings are likely to provide care to patients at risk of SHSe and/or those who regularly smoke around others. Currently, it is unclear how SHSe is addressed in UK primary and community care settings. Therefore, this study aimed to capture HCPs’ awareness, opinions, and practices around intervening with patients regarding SHSe in these settings.

Approach

Behaviour change theory was used in conjunction with existing literature to develop a cross-sectional survey that assessed HCPs’: (i) current practices around SHSe; and (ii) levels of capability, opportunity and motivation to intervene with patients regarding SHSe. This online survey was distributed to HCPs working in primary and community care settings across the UK at conferences, via twitter, and through networks affiliated with membership bodies and universities. Descriptive statistics and regression analyses were used to describe the data and assess participant characteristic effects on ‘practice’, ‘capability’, ‘opportunity’, and ‘motivation’.

Findings

Of 230 responses received August 2017-May 2018, 172 contributed to the full survey data analysis (encompassing data from 55 general practitioners, 25 nurses, 8 health visitors, 25 pharmacists, and 44 from other HCP groups). 140 respondents (81%) agreed or strongly agreed that they understood the health effects caused by SHS. However, 66 (38%) did not feel they had sufficient training about SHSe and a further 45 (26%) gave a neutral response. Response to the questions concerning level of capability to intervene was varied, with few respondents scoring highly on these questions (mean composite score=16.5 of maximum 25). Even fewer respondents scored highly for the questions concerning their level of opportunity to intervene around SHSe (mean composite score=10.9 of maximum 20). Only 34 (20%) felt well supported to intervene with patients around SHSe. Furthermore, pressures on time prioritisation reduced intervention opportunities. Respondents generally had a higher motivation level to intervene (mean composite score=18 of maximum 25) compared with their levels of capability or opportunity. 156 respondents (91%) considered SHSe interventions important. However, HCPs’ perception of patient engagement with such interventions was uncertain.Over half of the responses indicated that overall primary care-based HCPs never or rarely engage in practices around SHSe. Only 6 (4%) reported often or always asking, advising and acting on SHSe.

Consequences

The survey results show a clear need to provide further support to HCPs in primary and community care to enable them to help patients to reduce others’ exposure to second hand smoke. Future research should explore the development and testing of interventions to help bridge the gap between knowledge and clinical practice; a finding supported by existing global literature.