Readiness for implementation of smoke-free work hours in private companies: A qualitative study of perceptions among middle managers

Abstract

INTRODUCTION Workplaces are important settings for implementation of smoke-free environments. In this study, we follow a medical production company with 677 employees that implemented one of the most stringent tobacco policies legally possible in Denmark -smoke-free work hours -which means that employees are not allowed to smoke during work time. This study explores tobacco use restrictions during work hours regarding readiness of implementation, focusing specifically on middle managers' perceptions and considerations, as well as their perceived responsibility in enforcing these. METHODS A case study is presented. Two focus groups of 10 middle managers were conducted, seven months before smoke-free work hours were implemented. The facilitators used open-ended questions, which consisted of a structured section with specific themes related to the implementation of smoke-free work hours. Focus groups were recorded, transcribed, and analyzed thematically. RESULTS We identified five main themes: 1) Benefits of the new policy due to better health, lower sickness-related absences, increased productivity, and improved branding value; 2) Social interactions across smoking status; 3) Smoking is a private matter with ethical dimensions; 4) The role of middle managers and concerns about enforcement; and 5) Limited experience with resistance from the smoking employees. CONCLUSIONS The findings suggest that workplaces in the preparation phase should ensure that: 1) The middle managers gain training on how to talk with employees about smoking cessation; 2) The middle managers are equipped to handle the new policy and have a joint vision and understanding of why and how they should enforce it; and 3) Room is made for discussions on resistance and enforcementrelated challenges as well as ethical issues.

State of the literature discussing smoke-free policies globally: A narrative review

“…In addition to limited knowledge about smoke-free policies and the dangers of SHS, several studies cited a lack of training for stakeholders responsible for policy enforcement (e.g. law enforcement, hospital staff) as a barrier to enforcing smoke-free policies 21,27,44,108 . For example, one study of middle managers in a private company in Denmark found that, while middle managers supported smoke-free policies, they did not feel they were responsible for 'regulating other peoples' actions' and did not feel adequately prepared to address violations and discuss smoking cessation with their employees 108 .…”

“…law enforcement, hospital staff) as a barrier to enforcing smoke-free policies 21,27,44,108 . For example, one study of middle managers in a private company in Denmark found that, while middle managers supported smoke-free policies, they did not feel they were responsible for 'regulating other peoples' actions' and did not feel adequately prepared to address violations and discuss smoking cessation with their employees 108 . Thus, training for enforcement stakeholders that discusses the extent of their roles and responsibilities, protocol for responding to violations, and (in healthcare settings) providing smoking cessation services, can potentially increase compliance 27,44,66,68,73,74,95,108,109 .…”

Implementation fidelity of a smoke-free workplace intervention in a private medical company: A mixed-methods process evaluation

“…In the Danish context, smoke-free work hours include all tobacco-related products, that is, all tobacco and nicotine products (except medicinal nicotine replacement therapy) and other related products such as e-cigarettes without nicotine. Thus, the smoke-free work hours strategy is a much stricter prevention method than other strategies and is to our knowledge an unevaluated Scandinavian phenomenon 12 .…”