Faculty of Social Sciences, Health Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland.
Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
Syst Rev. 2019 Jul 19;8(1):177. doi: 10.1186/s13643-019-1086-5.
School tobacco policies (STPs) that aim to achieve a tobacco-free environment require consistent enforcement by school staff. However, little is known about why staff choose whether or not to enforce STPs. Therefore, we investigated staff members' responses to STPs that determine enforcement. Furthermore, we examined how these responses depend on contextual factors at the individual, interpersonal, school, implementation, and national levels.
We performed a realist review (RR), which synthesizes existing primary evidence into a programme theory demonstrating key causal pathways through Context-Mechanism-Outcome configurations (CMOs). These CMOs link contextual factors to outcomes (i.e. staff enforcement) by explaining the underlying generative mechanisms (i.e. staff members' cognitive, psychosocial, and behavioural responses). A systematic literature search for the period 2000-2016 was performed using Academic Search Premier, PsycInfo, and MEDLINE. Forty English-language articles were identified for the synthesis.
Our programme theory demonstrated three CMOs: when contextual factors make staff members experience STP enforcement as part of their professional role and duties, it may lead to staff members showing responsibility for STP enforcement (CMO1); when contextual factors make staff members feel their contribution is leading to positive outcomes, it may lead to staff members showing motivation to enforce STPs (CMO2), and when contextual factors make staff members feel that they are able to deal with students' responses, it may lead to staff members showing confidence in STP enforcement (CMO3). Moreover, the programme theory provided more precise insights into what contextual factors contribute to triggering the individual mechanisms and the consequent outcomes.
By applying a realist approach, we have been able to detect three CMOs explaining staff members' STP enforcement. The findings provide useful insights explaining how stakeholders can support staff members' STP enforcement and consequently improve the impact of STPs on adolescent smoking.
旨在实现无烟环境的学校烟草政策（STP）需要学校工作人员的一致执行。然而，对于工作人员选择是否执行 STP 的原因知之甚少。因此，我们调查了工作人员对决定执行 STP 的政策的反应。此外，我们还研究了这些反应如何取决于个人、人际、学校、实施和国家层面的背景因素。
我们进行了一项真实主义审查（RR），该审查将现有主要证据综合为一个方案理论，展示了通过上下文-机制-结果配置（CMO）的关键因果途径。这些 CMO 通过解释潜在的生成机制（即工作人员的认知、心理社会和行为反应）将背景因素与结果（即工作人员的执行）联系起来。使用 Academic Search Premier、PsycInfo 和 MEDLINE 对 2000 年至 2016 年期间的文献进行了系统搜索。综合分析了 40 篇英文文章。
我们的方案理论展示了三个 CMO：当背景因素使工作人员将 STP 执行视为其职业角色和职责的一部分时，这可能导致工作人员对 STP 执行负责（CMO1）；当背景因素使工作人员感到他们的贡献正在带来积极的结果时，这可能导致工作人员表现出执行 STP 的动力（CMO2），当背景因素使工作人员感到他们能够应对学生的反应时，这可能导致工作人员对 STP 执行有信心（CMO3）。此外，该方案理论更深入地了解了哪些背景因素有助于触发个人机制和随之而来的结果。
通过应用真实主义方法，我们能够检测到三个解释工作人员执行 STP 的 CMO。研究结果提供了有用的见解，解释了利益相关者如何支持工作人员执行 STP，从而提高 STP 对青少年吸烟的影响。
