Smoke-free homes: what are the barriers, motivators and enablers? A qualitative systematic review and thematic synthesis

Abstract

ObjectiveTo thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs).DesignSystematic review and thematic synthesis.Data sourcesSearches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists.Study selectionWe included 22 articles, reporting on 18 studies, involving 646 participants. Inclusion criteria: peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants’ perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH.Data extraction1 of 3 authors extracted data with checking by a second.Data synthesisA thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities.ConclusionsThis synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs.Trial registration numberCRD42014014115.

“He Doesn’t Listen to My Words at All, So I Don’t Tell Him Anything”—A Qualitative Investigation on Exposure to Second Hand Smoke among Pregnant Women, Their Husbands and Family Members from Rural Bangladesh and Urban India

“…Poor knowledge about SHS and the risks to the health of the fetus and children are consistent with the findings of a recent systematic review [34] that explores the barriers, motivators and enablers to smoke free homes. The review had a broader focus, i.e., it was not focused on pregnancy and drew on studies based predominantly in high income Western countries [34], which suggests that the need for interventions to include educational components are not unique to our study population.…”

Secondhand smoke exposure during pregnancy: a cross-sectional analysis of data from Demographic and Health Survey from 30 low-income and middle-income countries

“…Awareness of the harms associated with SHS is often lower in LMICs,34 and in some LMICs, due to patriarchal family structures, women may not feel comfortable challenging male smoking behaviour, even if they are aware of potential harm 34. Furthermore, weak tobacco control policies or implementation result in fewer protections against household SHS exposure and persistence of protobacco social norms.…”

Social disparities in children's exposure to secondhand smoke in privately owned vehicles

“…Most parents, including those of low SES, want to protect their children from SHS exposure and many report efforts to change their smoking behaviour for the sake of their children 47 48. Yet it may be that low SES parents experience greater barriers in having smoke-free private spaces49 and difficulty in establishing rules when it comes to the family car, with bans reported to be less likely in disadvantaged families 50…”