Family Practice Advance Access originally published online on July 29, 2005
Family Practice 2005 22(6):614-616; doi:10.1093/fampra/cmi082
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A short report: survey of practice nurses' attitudes towards giving smoking cessation advice
King's College London, Institute of Psychiatry, Department of Psychology, Health Psychology Section
Correspondence to Dr Sue Hall, Health Psychology Section, Department of Psychology, Institute of Psychiatry, King's College London, 5th Floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK; Email: sue.hall{at}kcl.ac.uk
Received 4 March 2005; Accepted 6 July 2005.
Hall S, Vogt F and Marteau TM. A short report: survey of practice nurses' attitudes towards giving smoking cessation advice. Family Practice 2005; 22: 614–616.
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Abstract |
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Background. Although practice nurses play an important role in implementing smoking cessation strategies in primary care, relatively little is known of their attitudes and beliefs about giving smoking cessation advice.
Objectives. To describe practice nurses' attitudes towards giving smoking cessation advice.
Methods. 152 of 200 (76%) practice nurses randomly selected from Medical Research Council General Practice Research Framework records completed a postal survey. The Attitudes to Smoking Cessation Advice Questionnaire was used.
Results. Overall, nurses were enthusiastic about giving smoking cessation advice and perceived such advice as effective. Nurses who were non-smokers perceived such advice as more effective than current smokers, as did those who had been trained in smoking cessation, who were also more enthusiastic than those who had not been trained.
Conclusion. Training all practice nurses in smoking cessation, and offering nurses who smoke effective smoking cessation services, is likely to help achieve Government targets for smoking cessation.
Keywords. Attitudes, health promotion, practice nurses, smoking cessation.
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Introduction |
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Smoking cessation guidelines for the UK acknowledge an important role for practice nurses in implementing smoking cessation strategies.1 A Cochrane review of nurses' smoking cessation interventions has shown that, overall, nurses are effective in motivating smokers to quit (Peto Odds Ratio 1.47, 95% CI 1.29 to 1.68).2 There was, however, substantial heterogeneity in the results of trials and their remains some uncertainty about such interventions in the context of multifactorial health checks. A number of potential barriers to nurses3 and GPs4 giving patients smoking cessation advice have been identified. These include, lack of necessary skills, perceiving advice giving as ineffective, lack of patient motivation and not having the time to give such advice. Such beliefs and attitudes have been shown to predict the smoking cessation activities of nurses.5 Despite their important role in smoking cessation strategies, relatively little is known of practice nurses' attitudes and beliefs about giving smoking cessation advice. The aim of this study is to describe these.
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Methods |
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Design
This cross-sectional survey of 200 practice nurses was conducted in January 2003. Participants were randomly selected from the Medical Research Council General Practice Research Framework (MRC GPRF). Attitudes towards giving smoking cessation advice (Table 1) are from the Attitudes to Smoking Advice Questionnaire,4 a measure reported to have good internal and construct validity. The two sub-scales (perceived effectiveness and enthusiasm for giving advice) had good internal reliability in the current study (Cronbach's
0.74 and 0.84 respectively). Means and proportions of nurses who agreed with each statement (agree = ratings 1–3, disagree = ratings 4–6) are reported.
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Results |
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152/200 nurses (76%) returned completed questionnaires. Their average age was 46.9 years (SD 7.2) and experience as a practice nurses 11.1 years (SD 6.6). Most were non-smokers (63%), 32% were ex-smokers and 5% were current smokers. The majority had been trained in smoking cessation (67%). 43% worked in practices in a Health Action Zone.
Overall, nurses had positive attitudes towards giving smoking cessation advice (Table 1). For example, few thought that giving anti-smoking advice should not be a part of their job. However, a substantial minority held a number of negative beliefs and attitudes towards providing smoking cessation advice. For example, 36% preferred to target smokers they felt would respond to their advice, 28% did not believe that discussing smoking with all smokers was an appropriate use of their time, 23% felt that discussing smoking with all smokers was likely to do more harm than good and 23% did not believe that their advice was effective.
Analyses of variance with Tukey's b tests for post hoc comparisons showed that nurses' perceptions of the effectiveness of their smoking cessation advice were associated with their current smoking status [F(2,149) 3.8, P = 0.025]. Ex-smokers and those who had never smoked perceived themselves as more effective in giving smoking cessation advice than current smokers [means (SDs): 4.8 (1.2), 4.5 (1.2), 3.7 (1.1) respectively]. Differences in enthusiasm for giving smoking cessation advice by these three groups approached significance [F(2,149) 2.7, P = 0.068] with ex-smokers being more enthusiastic than smokers [means (SDs): 5.1 (0.8), 4.3 (1.7)].
t-tests showed that, compared with nurses who reported not being trained in smoking cessation, those who reported such training were more enthusiastic about giving smoking cessation advice [t = 2.1,df = 150, P = 0.037, means (SDs): 4.6 (1.1), 5.0 (0.9)], and perceived themselves as more effective in giving it [t = 2.8, df = 150, P = 0.005, means (SDs): 4.2 (1.0); 4.8 (1.2)]. Nurses' age, experience and whether or not their practices were located in a Health Action Zone were each unrelated to their attitudes towards giving smoking cessation advice.
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Discussion |
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Overall practice nurses have positive attitudes towards giving patients smoking cessation advice. Nurses who have received no training in smoking cessation and those who smoke are less enthusiastic about giving smoking cessation advice and perceive such advice as less effective.
The proportion of nurses trained in smoking cessation is similar to the 66% reported in an earlier survey of practice nurses in the UK, which found a positive association between training in smoking cessation and activity relating to smoking cessation and positive attitudes towards giving such interventions.6 Effective training in smoking cessation for practice nurses is likely to increase the frequency with which patients in primary care are given smoking cessation advice and the effectiveness of such advice. This study confirms the more negative attitudes towards giving smoking cessation advice of nurses who smoke.3 These attitudes may be influenced by their own unsuccessful attempts to quit. As part of the recent public health White Paper Choosing health: making healthier choices easier, nurses are to be targeted to receive help to stop smoking. In addition to the benefits to their own health, nurses who succeed in quitting are likely to be more enthusiastic about giving smoking cessation advice to their patients.
In view of their important role in smoking cessation in primary care, practice nurses' positive attitudes towards giving their patients smoking cessation advice are encouraging. Achieving Government targets for smoking cessation is likely to be helped by training the substantial proportion of nurses as yet untrained in smoking cessation and offering all nurses who smoke effective smoking cessation services.
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Declaration |
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Funding: the Guy's & St Thomas' Charitable Foundation (R001103).
Ethical approval: the Eastern Multi-centre Research Ethics Committee (MREC 02/5/62).
Conflicts of interest: none.
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Acknowledgments |
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We thank the practice nurses who participated in the study, as well as the MRC GPRF for sending out the questionnaires.
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References |
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1 West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals. Thorax 2000; 55: 987–999.
2 Rice VH, Stead LF. Nursing interventions for smoking cessation. The Cochrane Library, issue 2, Chichester: John Wiley & Sons; 2004.
3 Sarna LP, Brown JK, Lillington L, Rose M, Wewers ME, Brecht ML. Tobacco Interventions by oncology nurses in clinical practice. Cancer 2000; 89: 881–889.[CrossRef][ISI][Medline]
4 Coleman T, Wilson A. Anti-smoking advice in general practice consultations: general practitioners' attitudes, reported practice and perceived problems. Br J Gen Pract 1996; 46: 87–91.[ISI][Medline]
5 Borelli B, Hecht JP, Papandonatos GD, Emmons KM, Tatewosian LR, Abrams DB. Smoking cessation counseling in the home: attitudes, beliefs, and behaviors of home healthcare nurses. Am J Prev Med 2001; 21: 272–277.[CrossRef][ISI][Medline]
6 McEwen A, West R. Smoking cessation activities by general practitioners and practice nurses. Tobacco Control 2001; 10: 27–32.
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