NHS patients, staff, and visitor viewpoints of smoking within a hospitals’ ground: a qualitative analysis

Abstract

BackgroundSmoking is a public health concern and an avoidable cause of morbidity and mortality. Widening tobacco control policies might help shift social norms, the acceptability of exposing others to second-hand smoke, and cultural attitudes towards smoking. This study explored patient, staff, and visitor viewpoints of smoking within the grounds of a National Health Service hospital.MethodsAnalysis of free text responses given as part of a larger repeat cross sectional questionnaire study. Free text qualitative responses analysed using thematic analysis. Pinderfields Hospital, a UK National Health Service hospital in the county of Yorkshire, provides a health service to around half a million people living in the Wakefield and North Kirklees area. Surveys were distributed 10th-18th September and 17th-21st December 2012. Of the n=952 participants who completed an anonymous survey n=306 participants provided a response to the optional free text question.ResultsThematic analysis revealed 5 distinct themes: (1) smoking is a dirty problem; (2) smokers are free to do as they wish; (3) the poor smoker; (4) smoke in our space: the battleground; and (5) no smoking please. Of the n=272 represented by the five themes, generally people accepted that smoking is socially unacceptable but their understanding of smoking behaviours and attitudes towards management and control of smoking differed. There was a strong sense that action is needed to separate the space smokers and non-smokers share. We identified a distinct group of participants that supported a hard line approach and suggested enforcing the no smoking policy through fines and monitoring.ConclusionsSmoking on hospital grounds remains a contentious issue. Participants acknowledge that smoking is an increasingly unacceptable social behaviour but their understanding and acceptance of smokers vary. There is a strong sense of dislike about the impact of smoke and smokers on the shared hospital environment, with a focus on the hospital entrance. Participants suggest separating smokers and non-smokers and moving smokers away from the hospital entrance with the introduction of smoking shelters. These results suggest a complex narrative that should be investigated further to inform the implementation of the no-smoking policy across hospital settings.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1015) contains supplementary material, which is available to authorized users.

Hospital entrance smoking is reduced by broadcasting recorded antitobacco messages from Australian primary school children over entrance public address system

“…Creating smoke-free environments denormalises tobacco use and supports increased quitting, but the presence of smokers at a busy hospital entrance undermines this public health message. 9,[18][19][20] Our data indicated the broadcasts of children voicing smokefree messages made the entrance a less appealing environment for F I G U R E 2 Daily summary of cigarettes/hr (bars), nonsmoker movements (solid line) and daytime temperature smoking, but frequency of messaging was important for significant effect. The original study design had 5-minutely broadcast intervals, but this plan occurred before the recording workshop, and the final sound bites obtained were shorter than anticipated.…”

“…Debate may occur on the value of such projects that use children's voices to potentially shame and stigmatise unwell people who smoke in health care setting, particularly those where assessment and treatment of tobacco dependency is suboptimal. Most would agree that smoking in the shared environment of a hospital entrance smoking is highly undesirable and difficult to manage, [18][19][20] so further research on ways to minimise is worthwhile.…”

The impact of a social norms approach on reducing levels of misperceptions around smokefree hospital entrances amongst patients, staff, and visitors of a NHS hospital: a repeated cross-sectional survey study

“…The survey investigated self-reported actual and perceived social norms associated with smoking in hospital entrances and on hospital grounds. Serafin et al reported the results of the secondary analysis of the free text responses provided by participants [ 15 ].…”

“…The introduction and implementation of the smokefree legislation in England in 2007 has had public health benefits by helping smokers to quit, reducing cigarette consumption and smoking prevalence [ 6 ]. While the national smoking ban inside buildings is understood and adhered to, there is a perception this has led to staff, patients and visitors smoking at hospital entrances and within hospital grounds [ 14 , 15 ]. Unintended consequences of smoking bans that inadvertently see a concentration of smokers at entrances or perimeters remain a public health concern [ 16 , 17 ].…”

The impact of smoke-free policies on smoking at outdoor sports clubs: a qualitative study

“…31e33 Smoking at entrances may give visitors a poor impression, increase smoking debris, and undermine the message of an SFP. 31,34 It is therefore important to identify solutions to resolve this recurrent problem. Previous studies have suggested expanding SFPs to entrance areas.…”