Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review

Stead, Martine; Angus, Kathryn; Holme, Ingrid; Cohen, David; Tait, Gayle

doi:10.3399/bjgp09x454007

Cited by 95 publications

(121 citation statements)

References 44 publications

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“…Only half recommend HCWs setting an example by not using tobacco, consistent with the findings from the treatment survey 5. Given the high reported rates of tobacco use by HCWs and students in some countries 7, 8, 9, 10, this remains a seriously neglected area.…”

Section: Discussionsupporting

confidence: 56%

A survey of tobacco dependence treatment guidelines content in 61 countries

et al. 2018

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AimsTo assess tobacco dependence treatment guidelines content in accordance with Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and its guidelines, and association between content and country income level.DesignCross‐sectional study.SettingOn‐line survey from March to July 2016.ParticipantsContacts in 77 countries, including 68 FCTC Parties, six Signatories and three non‐Parties which had indicated having guidelines in previous surveys, or had not been surveyed before.MeasurementsA nine‐item questionnaire on guidelines content, key recommendations, writing and dissemination.FindingsWe received responses from contacts in 63 countries (82%); 61 had guidelines. The majority are for doctors (93%), primary care (92%) and nurses (75%). All recommend brief advice, 82% recording tobacco use in medical notes, 98% nicotine replacement therapy (NRT), 61% quitlines, 31% text messaging and 87% intensive specialist support, and 54% stress the importance of health‐care workers not using tobacco. Only 57% have a dissemination strategy, and 62% have not been updated for 5 or more years. Compared with high‐income countries, quitlines are less likely to be recommended in upper middle‐income countries guidelines [odds ratio (OR) = 0.15, 95% confidence interval (CI) = 0.04–0.61] and intensive specialist support in lower middle‐income countries guidelines (OR = 0.01, 95% CI = 0.00–0.20). Guidelines updating is associated positively with country income level (P = 0.027).ConclusionsAlthough most tobacco dependence treatment guidelines in the 61 countries assessed in 2016 follow the World Health Organization's Framework Convention on Tobacco Control Article 14 recommendations and do not differ significantly by income level, improvements are needed in keeping guidelines up‐to‐date, applying good writing practices and developing a dissemination strategy.

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Section: Discussionsupporting

confidence: 56%

A survey of tobacco dependence treatment guidelines content in 61 countries

et al. 2018

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“…Studies conducted in Europe suggest that there is great diversity regarding GPs involvement in smoking cessation. This diversity is contingent on several factors, among which are the smoking behavior of the GPs, their attitudes towards smoking, reservations regarding inducing anxiety or guilt among pregnant women, but also self-confidence in providing cessation support 23 . A qualitative study involving family physicians (general practitioners) in Romania suggested that they generally feel untrained to offer smoking cessation support, emphasizing the need to integrate appropriate training in their professional development 24 .…”

Section: Discussionmentioning

confidence: 99%

Smoking and quitting smoking during pregnancy: A qualitative exploration of the socio-cultural context for the development of a couple-based smoking cessation intervention in Romania

Brînzaniuc¹,

Strilciuc²,

Cherecheș³

et al. 2018

Tob. Prev. Cessation

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INTRODUCTION Smoking during pregnancy has negative effects on the mother and the unborn infant. Barriers to and facilitators of smoking cessation during pregnancy are context-dependent and multifaceted. This qualitative research explored pregnant women's experiences with smoking and cessation in Romania, and informed the development of a couple-focused smoking cessation intervention. METHODS Semi-structured, in-depth interviews were conducted via telephone, with 15 pregnant women who smoked during pregnancy or had quit smoking upon learning about the pregnancy or shortly before. A hybrid inductive-deductive approach to thematic analysis was used, to identify patterns in the data and explore women's narratives, in relation to smoking and smoking cessation. RESULTS Three main themes emerged from the data, which shaped the socio-cultural adaptation of the intervention to the local context: 1) Access to and mixed messages from the healthcare system that describe an inconsistent discourse from the healthcare system regarding smoking during pregnancy with some physicians not emphasizing the need for cessation, 2) Cessation as individual or team effort with variations in partner dynamics and difficulty in quitting that have important roles in perceptions about team efforts, and 3) Transition to motherhood and motivation to quit for the health of the pregnancy and infant, although in isolated cases women felt less connected with the pregnancy and such motivators. CONCLUSIONS Pregnant women in Romania face systemic, interpersonal, and individuallevel barriers that can be responsively integrated in smoking cessation interventions, by culturally adapting them to the local context.

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“…Other barriers to treatment included feeling discomfort when asking about tobacco use, holding the opinion that counseling was not an appropriate service for them to provide, dealing with competing priorities, and believing that patients would resist advice. General practitioners cite limited time, insufficient training, and lack of reimbursement for counseling, in addition to their self-perceived lack of knowledge and skill in dealing effectively with tobacco-dependent patients (143).…”

Section: What We Knowmentioning

confidence: 99%