1. Primary care healthcare professionals’ knowledge, attitudes and practices towards promoting the reduction of children’s secondhand smoke exposure
Jaidev Kaur, Postgraduate Researcher Institute of Applied Health Research, University of Birmingham Supervised by: Dr Laura Jones, Dr Amanda Farley & Professor Kate Jolly
HI I’m Jaidev, and I’m a final year PhD student from the University of Birmingham in England. And for my research project I have been looking at whether we can use primary care settings to deliver harm reduction messages with the aim of protecting children from secondhand smoke exposure in cases where parents can’t or aren’t ready to give up smoking. In this presentation I am going the share the findings of the mixed methods systematic review that I did to start off this research project.
So I’m not sure how this compares with the Malaysian healthcare system, but in UK the primary care team is made up of a mixture of healthcare professionals so you have GPs who are medically trained and are considered by parents to be the most trusted source of information on children’s health; but you also have nurses in lots of different roles, you have dentists, pharmacists, phsiotherapists and lots more.

2. Ask Advise Act Background
Secondhand smoke exposure (SHSe) is still a significant problem in the UK
There is an online, free training resource available to UK healthcare professionals’ to support them in delivering Very Brief Advice
UK primary care services are well-placed for healthcare professionals to intervene around SHSe
Now we know that SHSe is still significant problem in the UK and Sean highlighted yesterday the Scottish data which shows this.
And we’ve spoken as part of the group discussions about the health consequences of SHSe
So bearing in mind that smokers and those exposed to SHS are likely to experience negative health impacts from the smoke, then they are likely to talk to healthcare professionals in primary care at various points in their lives. So this group of HCPs are very well-placed then to use these opportunities and their consultation skills to have discussions about SHS and to promote harm reduction to reduce exposure levels.
Now it has been identified that there is a lack of training for HCPs on the topic of SHS and so an online training resource was made to specifically support HCPs to deliver VBA – so this encourages the HCP to Ask about SHS, to provide advice on the topic and to follow this up with some kind of action to support patients to reduce the SHSe levels for non-smokers.

3. Rationale for systematic review
Aim: To explore the knowledge, attitudes and practices of primary care healthcare professionals around promoting the reduction of SHSe
To achieve this aim, we have systematically identified and synthesised the existing literature on primary care-based healthcare professionals’:
Knowledge and understanding of SHS
Current practices to promote SHSe reduction
Beliefs and experiences pertaining to the delivery of interventions to reduce SHSe
Perceived factors that influence the delivery of SHS-related interventions

4. Methods Phase 1: Mixed-methods systematic review of the literature
Sources
Search Tool
Inclusion Criteria
Exclusion Criteria
Medline
Setting
‘Primary Health Care’
1980+
Non-primary research
Reduced SHSe for non-smokers
CINAHL
Smoking cessation interventions
Population
‘Physicians’
PsychInfo
HCPs
Phenomenon of Interest
‘Tobacco Smoke Pollution’
EMBASE
Student HCPs
Primary care settings
Web of Science
Aggregated data from included and excluded datasets
Outcome
‘Health Knowledge, Attitudes and Practice’
English language
HMIC

5. Methods Mixed-methods synthesis
Phase 2: Mixed-methods synthesis
Mixed-methods synthesis
Meta-aggregation
Narrative presentation
Inductive, line-by-line coding
Themes and sub-themes were identified and interpreted
Qualitative data analysis and synthesis
Data separated into categories
Sub-themes were inductively identified
Quantitative data analysis and synthesis

6. Search results 3 – qualitative 17 – quantitative 19513
Articles identified
12591
Records were screened by title and abstract
188
Full-text articles were reviewed 20
Studies were included
3 – qualitative
17 – quantitative
USA (8), Sweden (3), Turkey (2), UK (2), Portugal (1), Netherlands (1), Italy (1), Canada (1), and Saudi Arabia (1)

7. Results of mixed-methods synthesis
Knowledge
Basic understanding of SHS and SHSe
Need training on practical application of this knowledge

8. Results of mixed-methods synthesis
Knowledge
Basic understanding of SHS and SHSe
Need training on practical application of this knowledge
Beliefs and experiences
Issue of high importance but not always the highest priority
Most felt they should ask/advise

9. Results of mixed-methods synthesis
Knowledge
Basic understanding of SHS and SHSe
Need training on practical application of this knowledge
Beliefs and experiences
Issue of high importance but not always the highest priority
Most felt they should ask/advise
Practices
Practices varied and were influenced by attitudes
More common to ask/advise rather than act
All actions were specific to cessation; none concerned SHSe harm reduction

10. Results of mixed-methods synthesis
Knowledge
Basic understanding of SHS and SHSe
Need training on practical application of this knowledge
Beliefs and experiences
Issue of high importance but not always the highest priority
Most felt they should ask/advise
Practices
Practices varied and were influenced by attitudes
More common to ask/advise rather than act
All actions were specific to cessation; none concerned SHSe harm reduction
Factors affecting practices
Many more reported barriers than facilitators, including:
impact on relationship with smoking parents
lack of support and training
lack of priority for issue

11. Findings and Implications
Need to develop supportive intervention packages
Deficit in practical action taken to support smokers to reduce SHSe levels
Lack of evidence around SHSe harm reduction approaches
Kaur, J., Farley, A., Jolly, K. and Jones, L. (2017). Primary Care Healthcare Professionals’ Knowledge, Attitudes, and Practices Towards Promoting the Reduction of Children’s Secondhand Smoke Exposure: A Mixed-Methods Review and Synthesis. Nicotine & Tobacco Research.
Kaur, J., Farley, A., Jolly, K. and Jones, L. (2017). Primary Care Healthcare Professionals’ Knowledge, Attitudes, and Practices Towards Promoting the Reduction of Children’s Secondhand Smoke Exposure: A Mixed-Methods Review and Synthesis. Nicotine & Tobacco Research.

12. Next steps... Qualitative study
Interviewing primary care-based healthcare professionals and patients who smoke and expose others to SHS
Local research study sampling from the West Midlands, UK
Quantitative study
Cross-sectional survey of UK primary care-based healthcare professionals
National, online research survey