Barriers to implementation of pediatric emergency department interventions for parental tobacco use and dependence: a qualitative study using the theoretical domains framework

Abstract

Background Pediatric emergency department (PED) and urgent care (UC) professionals can play a key role in delivering evidence-based guidelines to address parental tobacco use and child tobacco smoke exposure (TSE). Understanding PED/UC professionals’ perceptions regarding these guidelines is the first step in developing and implementing a TSE screening and counseling intervention in these settings. This study aimed to use the theoretical domains framework (TDF) to identify current screening and counseling behaviors of PED/UC professionals related to parental tobacco use and child TSE, and determine barriers and enablers that influence these behaviors. Methods Semi-structured, focused interviews were conducted with 29 actively practicing PED/UC clinical staff who worked at one large, Midwestern children’s hospital. The interview guide was informed by the TDF and included open-ended questions. Content analysis of interview transcripts was guided by the TDF. Nurses, physicians, and healthcare administrators were assessed overall and by group membership to ensure each group was represented based on their varying PED/UC roles. Results Fifty-one percent were nurses, 38% were physicians, and 11% were healthcare administrators. Most PED/UC professionals did not currently follow the guidelines, but perceived addressing parental tobacco use as part of their role. All 14 TDF domains were identified by nurses, physicians, and administrators in relation to counseling for parental tobacco use and child TSE. Domains with the most sub-themes were (1) knowledge: lack of knowledge about tobacco counseling, including implementing counseling, cessation resources/referrals, and thirdhand smoke; (2) beliefs about capabilities: not comfortable counseling parents, easier to discuss with parents who are receptive and to ask and advise when patients have a TSE-related complaint, and more likely to discuss if there were resources/referrals; and (3) environmental context and resources: barriers include lack of time, training, and resources and referral information to give to parents, and an enabler is using TSE-related complaints as a context to offer counseling. Conclusions Study findings provide a strong foundation for developing and implementing clinical practice guidelines regarding parental tobacco use and child TSE in the PED/UC setting. Future intervention development will address all TDF domains and test the implementation of the intervention in the PED/UC setting.

The Practice and Feasibility of Screening, Treatment, and Referral for Gaming Problems in Gambling, Alcohol and Other Drugs, and Youth Services

“…For example, one review on screening for harmful alcohol use in clinical settings reported clinician bias related to alcohol health literacy, knowledge of consumption guidelines, the degree of comfort in screening, and the perception of client willingness to be screened (Johnston, 2022 ). Another study on SBIRT for smoking cessation also reported deficits in knowledge inclusive of counselling methods and referrals, beliefs about capabilities and confidence to screen, and environmental context and resources like lack of time, training, and material information (Merianos et al, 2022 ). Attempts to implement SBIRT for gaming should consider each of these issues identified in the TDF prior to implementation and evaluate the degree to which they have been addressed.…”

LeadinCare: A Qualitative Informed Digital Training Platform Development to Increase Physicians’ Soft Communication Skills After COVID-19

“…The domains provide a theoretical lens through which one can identify all the cognitive, affective, and environmental influences on behavior. The TDF has been applied in many areas where changing physicians' behaviour is important, and has been employed, to better understand parameters that may facilitate or hinder an intervention's success (Abboud et al, 2022;Connell et al, 2014;Curran et al, 2013;Debono et al, 2017;Gondi et al, 2021;Huyer et al, 2018Huyer et al, , 2018Merianos et al, 2022;Patey et al, 2012). Despite its popularity, TDF has not yet been applied to understand physicians' challenges in implementing soft communication skills.…”