"It's a question of priorities, and smoking is not one of my priorities." Staff and patients' views of factors which affect the introduction of a smoking cessation service in a hospital

Callaghan, Margaret (2004) "It's a question of priorities, and smoking is not one of my priorities." Staff and patients' views of factors which affect the introduction of a smoking cessation service in a hospital. PhD thesis, University of Glasgow.

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Abstract

Aims and Introduction: This thesis aimed to investigate individual and structural factors affecting the introduction of a new smoking cessation service into an acute hospital in the West of Scotland. The research was carried out within the context of the growth of health promotion in hospitals and the increase in the provision of smoking cessation services in the UK and elsewhere. Smoking cessation services have been shown to be effective, however there has been little discussion of whether these are appropriate in acute hospitals. Furthermore there has been little research which has attempted to identify the factors which affect the implementation of these services or examined the attitudes of patients and staff towards them. Such research would help to assess whether these services were appropriate, and if so help to introduce them more effectively. Any findings would also have lessons for the introduction of other preventive health services. Methods: Quantitative and qualitative methods were used. Patients took part in a survey which was carried out before the service was set up and staff were interviewed in depth as the service was being set up. Inpatients and outpatients attending the hospital for treatment in the medical department were surveyed either immediately after their outpatient appointment or during their inpatient stay. The survey aimed to determine what smoking advice was given before the service was introduced and whether patients felt such advice and the provision of a dedicated service were appropriate in this context. The patient survey was originally intended to be repeated after the smoking cessation service had been in place for twelve months in order to estimate the effect of the service on the smoking cessation advice which patients were offered. However due to an eleven- month delay in the employment of the smoking coordinator this was not possible and the aims of the thesis were changed. In addition twenty key people, including both clinical and management staff, were interviewed in depth. Interviewees were chosen because of their role in the hospital or because they had some impact on the development of the smoking cessation service. These interviews aimed to identify their perceptions of individual and structural barriers which would affect the implementation of the smoking cessation service in the hospital. Interviews were analysed thematically. Results: The survey results showed that a third of the patients were current smokers. Sixty-six percent of inpatients and 40% of outpatients reported that they were asked if they smoked during their visit to the hospital, and smokers were significantly more likely to report this than non-smokers. Of those who smoked, 44% reported that they had been advised to stop smoking. However few had been offered any help to do so. The majority were unaware of any services to help smokers to stop smoking though they believed that such a service would be appropriate. Half of the smokers wanted help to stop smoking. The findings from the in depth interviews showed that most interviewees with a clinical role believed that they routinely asked patients if they smoked and advised them to stop but only if they felt that this advice was appropriate. This depended largely on their perception of patients' motivation and whether smoking was related to their presenting illness. Clinicians who smoked were more reluctant to routinely ask patients about smoking than non-smokers. Interviewees did not accept without question that all patients should be advised to stop smoking and felt that this should be targeted at the appropriate groups. Interviewees discussed their health-promoting role and, while they believed that they were responsible for health promotion, largely preferred to give advice which was related to the work which they did and the patients presenting illness. Interviewees were concerned that the patients should be given advice at an appropriate time when they were able to listen to this and were willing to change, and concern was expressed that patients would not sustain any health change once they returned to their home environment. One of the main themes to emerge from these interviews was that staff felt under enormous time pressures. Clinical staff, in particular', felt under pressure because of their knowledge of waiting lists and the number of patients whom they had to see. This made it difficult to engage with patients and thus give them advice. Management staff too were concerned with waiting lists and discussed at length strategies to decrease them. The smoking cessation coordinator often found it difficult to arrange to see staff because they did not have enough time to see her. A change in government policy at the time the study was being earned out resulted in an increase in the number of smoking cessation services in general practice and decreased the need for such services in hospital. Conclusion: In conclusion it was clear that patients felt that smoking advice was appropriate and acceptable in the hospital. Many patients wanted to stop smoking and most of these wanted help to do so. Staff were generally positive towards the provision of the smoking service and accepted that they had a health promoting role. However barriers, in particular at a structural level, were likely to prevent the service from meeting its objectives. Specifically, it is unlikely that the culture of this hospital will be changed so that smoking cessation services are routinely offered.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Advisers: Graham Hart; Mark Petticrew
Keywords: Public health, Health care management
Date of Award: 2004
Depositing User: Enlighten Team
Unique ID: glathesis:2004-71178
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 10 May 2019 10:49
Last Modified: 10 May 2019 10:49
URI: http://theses.gla.ac.uk/id/eprint/71178

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