Smoke-free hospitals: perceptions, experiences and behaviours of healthcare providers

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University of New Brunswick


Smoking tobacco is the leading preventable cause of premature disease and death, yet nearly 4.2 million Canadians still smoke despite the gains that have been made in tobacco control (Government of Canada, 2015). Tobacco control initiatives, such as smoke-free hospital properties, have the potential to create opportunities to promote healthy choices, influence how tobacco use is managed, and reduce the use and exposure of tobacco (Shopik, Schultz, Nykiforuk, Finegan, & Kvern, 2012); however, tobacco dependence is often not considered a frontline issue when exploring the impact of tobacco control interventions (Schultz, Bottorff, & Johnson, 2006). The purpose of this study was to explore how the implementation of a comprehensive smoke-free hospital policy influenced the perceptions, experiences, and behaviors of healthcare providers including: perceived roles and behaviors in tobacco dependence treatment; perceived barriers and facilitators to offering tobacco dependence treatment; and the overall perception of workplace culture as it relates to tobacco. The outline for this publication-based dissertation includes: an introduction, two background manuscripts, a research plan outline, one manuscript with the study findings, and a conclusion. The introductory chapter provides context for the dissertation and explains the cohesiveness of the individual manuscripts. The first manuscript explores the background on smoke-free hospital properties to illuminate this important healthcare initiative and to provide a foundation to understand the current climate. The second manuscript examines and applies four commonly used health promotion theories to inform the development of a smoke-free hospital program theory. This was used to enhance awareness of potential influencers for exploration during the research study. A bridging chapter provides the rationale and background on the research design and ethical considerations. The third manuscript provides the main study findings on how the implementation of a comprehensive smoke-free hospital policy influenced healthcare providers’ perceptions, experiences, and behaviors. The four overarching themes include: 1) greater support for tobacco reduction; 2) enhanced patient care and interactions; 3) improved staff morale; and 4) some barriers still exist. The dissertation concludes with a summary of each manuscript related to the field of study, as well as implications for practice, research, education, and policy.