Barriers and Challenges of Implementing Tobacco Control Policies in Hospitals: Applying the Institutional Analysis and Development Framework to the Catalan Network of Smoke-Free Hospitals

Martínez, Cristina

doi:10.1177/1527154409346736

Cited by 14 publications

(23 citation statements)

References 39 publications

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“…This framework has been used in studies of smokeand tobacco-free policy compliance (Fallin, 2011;Martinez, 2009). The IAD encompasses three nested levels of action: constitutional, collective choice, and operational.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Smoke-Free Policy Implementation: Theoretical and Practical Considerations

Fallin

Goodin

Rayens

et al. 2014

Policy, Politics, & Nursing Practice

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Secondhand smoke exposure is a major public health issue, increasing the risk of cardiovascular and respiratory diseases and cancer. Although best practices for adopting smoke-free policy are well understood, there is limited research on the effective implementation of smoke-free policy. This article presents theoretical and practical considerations for smoke-free policy implementation in three Kentucky communities guided by the Institutional Analysis and Development (IAD) Framework. Although both Danville and Lexington-Fayette County, Kentucky have comprehensive smoke-free policies, Danville had more effective implementation, as well as better outcomes. Further study is needed to understand the critical elements of smoke-free policy implementation and their association with population outcomes. The IAD is a promising model to guide the study of both policy adoption and implementation.

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Section: Conceptual Frameworkmentioning

confidence: 99%

Smoke-Free Policy Implementation: Theoretical and Practical Considerations

Fallin

Goodin

Rayens

et al. 2014

Policy, Politics, & Nursing Practice

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“…In Spain, currently 29% of adults (>15 years old) are smokers (European Commission, ). In Catalonia (nation in the northeastern part of Spain), several actions have been undertaken to implement tobacco control interventions in hospitals beyond the legislative framework (Martínez, ; Mendez, Garcia, Margalef, Fernandez, & Peris, ). Since 2000, the Catalan Network for Smoke‐free Hospitals (Xarxa Catalana de Hospitales sin Humo [XCHsF], http://www.xchsf.cat) has promoted a tobacco control policy based on organizational and cultural change.…”

mentioning

confidence: 99%

“…Training all healthcare workers to record smoking use and offer brief smoking cessation interventions is a basic and effective method to improve the successful implementation of smoking cessation guidelines (Carson et al, 2012). But besides the lack of training (Stead et al, 2009;Tong, Strouse, Hall, Kovac, & Schroeder, 2010), other barriers, which have been identified to prevent its broad implementation, include health professionals' own smoking consumption; lack of time (Tong et al, 2010); low motivation, knowledge, and confidence (Applegate, Sheffer, Crews, Payne, & Smith, 2008;Leitlein, Smit, de Vries, & Hoving, 2012;Martínez, 2009;Sarna et al, 2009;Smit, de Vries, & Hoving, 2013); the deficiency of protocols, records, educational materials, and pharmacological aids (Eby, Laschober, & Muilenburg, 2014;Freund et al, 2009;Leitlein et al, 2012;Smith, Sellick, & Spadoni, 2012); and insufficient organizational support from supervisors and co-workers (Choi & Kim, 2016;Laschober, Muilenburg, & Eby, 2015;Segaar, Bolman, Willemsen, & Vries, 2006). Therefore, training, as well as eliminating individual and organizational barriers to tobacco dependence treatment in a healthcare setting, is essential (Williams et al, 2015).…”

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confidence: 99%

Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals

Martı́nez¹,

Castellano

Andrés

et al. 2019

J of Nursing Scholarship

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Purpose To assess changes in the self‐reported performance of smoking cessation interventions according to the 5A's model (Ask; Advise; Assess; Assist; and Arrange follow‐up) among clinicians; and to identify the main barriers and facilitators in smoking cessation implementation before and after an online smoking cessation training program. Design Pre‐post evaluation. Methods We assessed self‐reported smoking cessation interventions in the implementation of the 5A's model among clinicians working in Catalan hospitals (Spain). In addition, we assessed individual‐, behavioral‐, and organizational‐level factors that act as barriers and facilitators in the implementation of the 5A's model. We used a questionnaire of 63 items reflecting each of the 5A's performance (scored from 0 = none to 10 = most possible). The questionnaire was completed both immediately before and 6 months after the training. We analyzed the data of those participants who had a clinical role and answered pre‐ and post‐questionnaires. We used the nonparametric test for paired data (Wilcoxon) to examine changes in scores. Findings A total of 127 clinicians completed the pre‐post questionnaire; 63.0% were registered nurses, 17.3% were nursing assistants, 7.9% were physicians, and 11.8% were other professionals (p < .001). Overall, there were significant increases in the implementation of the assist component (from a score of 4.5 to 5.2; p < .003) and arrange a follow‐up component (from 3.6 to 4.5; p < .001) of the intervention. Scores in the perception of the level of overall preparation, preparedness in using smoking cessation drugs, level of competence, and organizational recognition improved (p < .001) at the follow‐up; however, the score in the perception that implementing smoking cessation is part of their job decreased (from 6.3 to 4.4; p < .001). Conclusions The online training had a positive impact on the implementation of assist and arrange follow‐up components. Although self‐preparedness in the management of smokers increased, the motivation and involvement of key professionals decreased. Organizational factors related to the incorporation of resources (such as protocols, records, etc.) should be improved for the correct progression of smoking cessation interventions within the institutions. Clinical Relevance Smoking cessation training programs should incorporate some motivational content to increase the engagement of health professionals in smoking cessation interventions in their clinical practice.

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“…One of such frameworks that can be utilized to evaluate HISs is the Institutional Analysis and Development (IAD) framework, which was described by Ostrom (1994). It is a framework that has been used in the health sector through what is called as Health Policy Analysis Framework [18]. In principle, IAD is a systematic method for organizing policy analysis activities that is compatible with a wide variety of more specialized analytic techniques used in the physical and social sciences.…”

Section: Evaluation Framework Of His: Institutional Analysis and Devementioning

confidence: 99%

Evaluation of Health Information System (HIS) in The Surveillance of Dengue in Indonesia: Lessons from Case in Bandung, West Java

Faridah

Rinawan

Fauziah

et al. 2020

IJERPH

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This study was performed to evaluate the health information system regarding the dengue surveillance system in Indonesia. Major obstacles to the implementation of an effective health information system regarding dengue cases in Bandung are examined, and practical suggestions on measures to overcome them are discussed. The study utilized a mixed-method research design using qualitative approaches: document analysis, key informants and focus group interviews. Thirty key informants were selected, comprised of policymakers, senior managers, and staff at the Ministry of Health. Data from documents and transcripts were evaluated through a modified Institutional Analysis and Development (IAD) framework described by Ostrom. Through this study, we have identified several issues that hinder the effective implementation of the health information system in the case of dengue in Bandung. In the end, we propose several recommendations for reform that encompasses motivational, strategic, and structural approaches to each component of the analysis. Through evaluation of the health information system for dengue surveillance in Indonesia, we conclude that well-coordination in multi-level governance in a country as large as Indonesia is the key in the implementation of the health information system in different levels of agencies. Furthermore, the adaptability of human resources in adopting a new information system also plays an important part.

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Barriers and Challenges of Implementing Tobacco Control Policies in Hospitals: Applying the Institutional Analysis and Development Framework to the Catalan Network of Smoke-Free Hospitals

Cited by 14 publications

References 39 publications

Smoke-Free Policy Implementation: Theoretical and Practical Considerations

Smoke-Free Policy Implementation: Theoretical and Practical Considerations

Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals

Evaluation of Health Information System (HIS) in The Surveillance of Dengue in Indonesia: Lessons from Case in Bandung, West Java

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