Primary care healthcare professionals’ knowledge, attitudes and practices towards promoting the reduction of children’s secondhand smoke exposure Jaidev Kaur, Postgraduate Researcher Institute of Applied Health Research, University of Birmingham Supervised by: Dr Laura Jones, Dr Amanda Farley & Professor Kate Jolly HI I’m Jaidev, and I’m a final year PhD student from the University of Birmingham in England. And for my research project I have been looking at whether we can use primary care settings to deliver harm reduction messages with the aim of protecting children from secondhand smoke exposure in cases where parents can’t or aren’t ready to give up smoking. In this presentation I am going the share the findings of the mixed methods systematic review that I did to start off this research project. So I’m not sure how this compares with the Malaysian healthcare system, but in UK the primary care team is made up of a mixture of healthcare professionals so you have GPs who are medically trained and are considered by parents to be the most trusted source of information on children’s health; but you also have nurses in lots of different roles, you have dentists, pharmacists, phsiotherapists and lots more.

Ask Advise Act Background Secondhand smoke exposure (SHSe) is still a significant problem in the UK There is an online, free training resource available to UK healthcare professionals’ to support them in delivering Very Brief Advice UK primary care services are well-placed for healthcare professionals to intervene around SHSe Now we know that SHSe is still significant problem in the UK and Sean highlighted yesterday the Scottish data which shows this. And we’ve spoken as part of the group discussions about the health consequences of SHSe So bearing in mind that smokers and those exposed to SHS are likely to experience negative health impacts from the smoke, then they are likely to talk to healthcare professionals in primary care at various points in their lives. So this group of HCPs are very well-placed then to use these opportunities and their consultation skills to have discussions about SHS and to promote harm reduction to reduce exposure levels. Now it has been identified that there is a lack of training for HCPs on the topic of SHS and so an online training resource was made to specifically support HCPs to deliver VBA – so this encourages the HCP to Ask about SHS, to provide advice on the topic and to follow this up with some kind of action to support patients to reduce the SHSe levels for non-smokers.

Rationale for systematic review Aim: To explore the knowledge, attitudes and practices of primary care healthcare professionals around promoting the reduction of SHSe To achieve this aim, we have systematically identified and synthesised the existing literature on primary care-based healthcare professionals’: Knowledge and understanding of SHS Current practices to promote SHSe reduction Beliefs and experiences pertaining to the delivery of interventions to reduce SHSe Perceived factors that influence the delivery of SHS-related interventions

Methods Phase 1: Mixed-methods systematic review of the literature Sources Search Tool Inclusion Criteria Exclusion Criteria Medline Setting ‘Primary Health Care’ 1980+ Non-primary research Reduced SHSe for non-smokers CINAHL Smoking cessation interventions Population ‘Physicians’ PsychInfo HCPs Phenomenon of Interest ‘Tobacco Smoke Pollution’ EMBASE Student HCPs Primary care settings Web of Science Aggregated data from included and excluded datasets Outcome ‘Health Knowledge, Attitudes and Practice’ English language HMIC

Methods Mixed-methods synthesis Phase 2: Mixed-methods synthesis Mixed-methods synthesis Meta-aggregation Narrative presentation Inductive, line-by-line coding Themes and sub-themes were identified and interpreted Qualitative data analysis and synthesis Data separated into categories Sub-themes were inductively identified Quantitative data analysis and synthesis

Search results 3 – qualitative 17 – quantitative 19513 Articles identified 12591 Records were screened by title and abstract 188 Full-text articles were reviewed 20 Studies were included 3 – qualitative 17 – quantitative USA (8), Sweden (3), Turkey (2), UK (2), Portugal (1), Netherlands (1), Italy (1), Canada (1), and Saudi Arabia (1)

Results of mixed-methods synthesis Knowledge Basic understanding of SHS and SHSe Need training on practical application of this knowledge

Results of mixed-methods synthesis Knowledge Basic understanding of SHS and SHSe Need training on practical application of this knowledge Beliefs and experiences Issue of high importance but not always the highest priority Most felt they should ask/advise

Results of mixed-methods synthesis Knowledge Basic understanding of SHS and SHSe Need training on practical application of this knowledge Beliefs and experiences Issue of high importance but not always the highest priority Most felt they should ask/advise Practices Practices varied and were influenced by attitudes More common to ask/advise rather than act All actions were specific to cessation; none concerned SHSe harm reduction

Results of mixed-methods synthesis Knowledge Basic understanding of SHS and SHSe Need training on practical application of this knowledge Beliefs and experiences Issue of high importance but not always the highest priority Most felt they should ask/advise Practices Practices varied and were influenced by attitudes More common to ask/advise rather than act All actions were specific to cessation; none concerned SHSe harm reduction Factors affecting practices Many more reported barriers than facilitators, including: impact on relationship with smoking parents lack of support and training lack of priority for issue

Findings and Implications Need to develop supportive intervention packages Deficit in practical action taken to support smokers to reduce SHSe levels Lack of evidence around SHSe harm reduction approaches Kaur, J., Farley, A., Jolly, K. and Jones, L. (2017). Primary Care Healthcare Professionals’ Knowledge, Attitudes, and Practices Towards Promoting the Reduction of Children’s Secondhand Smoke Exposure: A Mixed-Methods Review and Synthesis. Nicotine & Tobacco Research. Kaur, J., Farley, A., Jolly, K. and Jones, L. (2017). Primary Care Healthcare Professionals’ Knowledge, Attitudes, and Practices Towards Promoting the Reduction of Children’s Secondhand Smoke Exposure: A Mixed-Methods Review and Synthesis. Nicotine & Tobacco Research.

Next steps... Qualitative study Interviewing primary care-based healthcare professionals and patients who smoke and expose others to SHS Local research study sampling from the West Midlands, UK Quantitative study Cross-sectional survey of UK primary care-based healthcare professionals National, online research survey