Jones S E, Mulrine S, Clements H, Hamilton S
School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
School of Geography, Politics and Sociology, Newcastle University, Newcastle, UK.
BMC Public Health. 2020 Oct 28;20(1):1619. doi: 10.1186/s12889-020-09673-7.
Life expectancy is 10-20 years lower among people with a severe mental health disorder. Most of these early deaths are due to chronic conditions, including cardiovascular and respiratory diseases. Smoking is a major risk factor for these conditions and introducing smokefree policies has been recommended to mental health service providers in England by the National Institute for Health and Care Excellence (NICE), in their Public Health Guideline 48: Smoking: acute, maternity and mental health services. This paper reports a process evaluation of introducing these policy recommendations, which were updated in 2013.
Process data were collected through semi-structured interviews with staff (n = 51), members of partnering organisations (n = 5), service users (n = 7) and carers (n = 2) between November 2016 - April 2017. Normalization Process Theory (NPT) was used to design the data collection tools and analyse the data. A framework approach was taken with the analysis, using the four concepts of NPT: coherence, cognitive participation, collective action and reflexive monitoring.
The policy made sense to some staff, patients and carers (coherence) who 'bought-into' the idea (cognitive participation) but other participants disagreed. Although smokefree policies were operationalised (collective action), sometimes they were opposed. Progress was made, especially in some units, but continued to be resisted in others. Informal appraisal of progress (reflexive monitoring) presented a varied picture.
Some progress has been made in terms of changing an entrenched, smoking culture into one that is smokefree on Trust sites across the region. Perseverance and resourcing over the long-term is required to establish a non-smoking culture in on-site provision of mental health services.
患有严重精神健康障碍的人群预期寿命要低10至20年。这些过早死亡大多归因于慢性疾病，包括心血管疾病和呼吸系统疾病。吸烟是这些疾病的主要风险因素，英国国家卫生与临床优化研究所（NICE）在其第48号公共卫生指南《吸烟：急症、孕产妇及精神健康服务》中，建议精神健康服务提供者推行无烟政策。本文报告了对推行这些于2013年更新的政策建议的过程评估。
2016年11月至2017年4月期间，通过对工作人员（n = 51）、合作组织成员（n = 5）、服务使用者（n = 7）和护理人员（n = 2）进行半结构化访谈收集过程数据。运用归一化过程理论（NPT）设计数据收集工具并分析数据。分析采用框架法，运用NPT的四个概念：连贯性、认知参与、集体行动和反思性监测。
该政策对一些“认同”这一理念的工作人员、患者和护理人员来说是有意义的（连贯性），但其他参与者则持不同意见。尽管无烟政策得以实施（集体行动），但有时会遭到反对。取得了一些进展，尤其是在一些单位，但在其他单位仍遭到抵制。对进展的非正式评估（反思性监测）呈现出不同的情况。
在将一种根深蒂固的吸烟文化转变为该地区各信托机构场所内的无烟文化方面已取得了一些进展。要在现场提供精神健康服务时建立无烟文化，需要长期的坚持和资源投入。
