Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
National Addiction Centre, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
BMC Psychiatry. 2019 Feb 4;19(1):54. doi: 10.1186/s12888-019-2029-3.
Smoking has played a significant role in the historical culture of mental healthcare settings. Mental health professionals (MHPs) often hold dismissive attitudes regarding the importance of smoking cessation in the context of mental healthcare. In 2007, English mental health inpatient buildings were required by law to become smoke-free, and healthcare trusts have more recently begun to implement comprehensive policies (i.e. smoke-free grounds and buildings) and staff training in response to national guidance. It is therefore important to explore MHPs practice around smoking, smoking cessation, and smoke-free policy adherence. This study aimed to explore these issues by using the COM-B (capability, opportunity, motivation, behaviour) model to systematically identify barriers to, and facilitators for, MHPs addressing smoking with their patients.
Five focus groups with a total of 36 MHPs were conducted between March and August 2017. MHPs were recruited from one of the largest mental health trusts in Europe. Discussions were guided by a semi-structured guide. Responses were audio recorded, transcribed and coded using thematic analysis and the COM-B framework.
Addressing smoking with patients was undermined by MHPs' 1) psychological capability to recall training content, misunderstand the potential benefits of addressing patient smoking and harm reduction approaches; 2) physical opportunity in terms of time constraints, and easy accessibility of tobacco in the community; 3) social opportunity in terms of increased cultural value of tobacco following inpatient smoke-free policy implementation, and lack of support from colleagues to enforce the smoke-free policy; 4) automatic motivation, including intrinsic biases regarding patients abilities and motivations to quit, and 5) reflective motivation, including perceived job role and decision making processes related to addressing behaviours deemed more important than smoking. The main facilitating factors identified were MHPs' having opportunity in the form of patients asking directly for support, and MHPs having access to resources such as stop smoking services and spirometers.
Multiple barriers were identified across all key domains of the COM-B framework that undermine MHPs' practice regarding smoking cessation. Few facilitators were identified which may have implications for future smoke-free policy and clinical practice.
吸烟在精神卫生保健机构的历史文化中扮演了重要的角色。精神卫生专业人员（MHPs）通常对精神保健中戒烟的重要性持轻视的态度。2007 年，英国的精神卫生住院楼被法律要求禁烟，而医疗保健信托基金最近也开始根据国家指导方针，实施全面的政策（即禁烟场所和建筑）和员工培训。因此，探索 MHPs 在吸烟、戒烟和遵守无烟政策方面的实践情况非常重要。本研究旨在通过使用 COM-B（能力、机会、动机、行为）模型来系统地确定 MHPs 与患者讨论吸烟问题的障碍和促进因素，从而探讨这些问题。
2017 年 3 月至 8 月期间，共进行了 5 次焦点小组讨论，共有 36 名 MHPs 参加。MHPs 是从欧洲最大的精神卫生信托之一招募的。讨论由半结构化指南指导。使用主题分析和 COM-B 框架对音频记录、转录和编码的响应进行分析。
与患者讨论吸烟问题受到 MHPs 的以下方面的阻碍：1）心理能力，即回忆培训内容的能力，对解决患者吸烟问题和减少危害方法的潜在益处的误解；2）身体机会，包括时间限制和社区中烟草的易获得性；3）社会机会，包括住院禁烟政策实施后烟草文化价值的增加，以及缺乏同事支持来执行无烟政策；4）自动动机，包括对患者戒烟能力和动机的内在偏见；5）反射动机，包括与解决被认为比吸烟更重要的行为相关的工作角色和决策过程。确定的主要促进因素包括 MHP 有机会让患者直接寻求支持，以及 MHP 可以获得戒烟服务和肺活量计等资源。
在 COM-B 框架的所有关键领域都确定了多个障碍，这些障碍削弱了 MHPs 在戒烟方面的实践。确定的促进因素很少，这可能对未来的无烟政策和临床实践产生影响。
