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Parents’ Perceptions of Barriers and Facilitators to Smoke-Free Homes and
Vehicles
Rosemary Herbert PhD(c)CPHA, 2008
Researchers
Rosemary Herbert RN, PhD(c) Anita Gagnon RN, MPH, PhD Janet Rennick RN, MScN, PhD Jennifer O’Loughlin PhD
Background
Children’s ETS Exposure in the Home
▪ 9.2% Canadian children <12 years
(Health Canada, 2007)
▪ 35% American children <18 years
(ALA, 2007)
▪
Adverse Effects ETS
Respiratory problems Low birth weight SIDS Ear infections Cardiovascular problems Behavioral problems, learning difficulties
(California Environmental Protection Agency, 1997; Gidding, 1999; Health Canada, 2004; Mitchell & Milerad, 1999; Strachan & Cook,1997,1998; WHO, 1999).
Research Objective
To describe parents’ perceptions of barriers to making homes and vehicles smoke-free, and to identify facilitators used by parents to manage these barriers.
Methods
RCT tested intervention designed to empower parents to make homes smoke-free
Semi-structured interview data about barriers and facilitators to smoke-free homes and vehicles collected at 6 months follow-up
Eligibility Criteria
At least one cigarette per day was smoked within the home
The family had one or more children aged ≤5 years who resided in the home at least 50% of the time
One parent (not necessarily a smoker) willing to participate in the intervention
Data Collection
What the barriers were to making homes and vehicles smoke-free, including the greatest barriers
What they did to overcome barriers and what worked best
What they would recommend to others
Data Analysis
Inductive approach Data coded by two people Themes assigned to codes with similar
meaning Coders reached consensus
(Thomas, 2008; Ulin, Robinson, & Tolley, 2005)
Results
Participants 33 mothers, 3 fathers, aged 18-42 11 (31%) < high school 16 (44%) < $15,000 household income 21 (58%) >1 child 28 (78%) of the families, mothers smoked during
pregnancy 29 (80%) of the families, mothers were current
smokers
Barriers to Smoke-Free Homes
Themes congruent with ecological model of health promotion
Intrapersonal (within individual) Interpersonal (between individuals) Physical Environmental
(McLeroy et al.,1988; Stokols,1996)
Most Common Barriers to Smoke-Free Homes
Intrapersonal Barriers Nicotine addiction Time and effort required to make the
change
“I can’t quit. It’s the addiction part of it.”
(20 year old, single mother of two)
Barriers to Smoke-Free Homes
Interpersonal Barriers Supervising young children Partners and relatives wanting to
smoke in the home
“It’s hard to bundle her up and go outside. I can’t leave her unattended.”
(20 year old single mother of a one year old)
Barriers to Smoke-Free Homes
Physical Environmental Barriers Inclement Weather Lack of access to the outside
“My daughter is too young to leave alone.”
(27 year old single mother of a three year old child who lived in a third floor apartment with no balcony).
Barriers to Smoke-Free Vehicles
Intrapersonal Barriers Habit of smoking while driving“I love to smoke when I’m driving.” (27 year old mother of two children )
Interpersonal Barriers Habits and routines of partners and
relatives
Facilitators to Smoke-Free Homes and Vehicles
Intrapersonal Quitting or considering quitting, smoking less, altering smoking location, reminding self of the change, making the decision to go smoke-free
“ I tried ‘I’ statements learned in the group instead of ‘You should.’ ”
(27 year old mother of four)
Facilitators to Smoke-Free Homes and Vehicles
Interpersonal Talking with household members Ending relationship with partner Moving to a new location
“Moving out, that worked best. I got tired of fighting with them about the smoking.”
(20 year old single mother of two who had previously lived with her parents)
Facilitators That Worked Best
Interpersonal Facilitators Related to children Informing people home was smoke-free
“Letting people know that there’s no smoking in the house…it you get annoyed enough they get the point.”
(32 year old mother of five children)
Recommendations to Others
Being committed to the change Being consistent Quickly initiating the change Quitting smoking Learning about the effects of ETS
Limitations
Data were collected in follow-up interviews for RCT
Interviews that focused solely on smoke-free homes and vehicles may have provided more in-depth data
Implications
Multiple barriers existed for these parents, most of whom were mothers, many with low-SES
Most effective facilitators involved others yet parents most often relied on themselves
None identified health care providers as facilitators
Implications
No single course of action will suit all families
Health care providers need to assess each parent’s context and offer individualized suggestions
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