Abstract
Introduction Evidence-based smoking cessation and temporary abstinence interventions to address smoking in mental health settings are available, but the impact of these interventions is limited.Aims and MethodsWe aimed to identify and synthesize the perceived barriers and enablers to supporting smoking cessation in mental health settings. Six databases were searched for articles reporting the investigation of perceived barriers and enablers to supporting smoking cessation in mental health settings. Data were extracted and coded using a mixed inductive/deductive method to the theoretical domains framework, key barriers and enablers were identified through the combining of coding frequency, elaboration, and expressed importance.ResultsOf 31 included articles, 56 barriers/enablers were reported from the perspectives of mental healthcare professionals (MHPs), 48 from patient perspectives, 21 from mixed perspectives, and 0 from relatives/carers. Barriers to supporting smoking cessation or temporary abstinence in mental health settings mainly fell within the domains: environmental context and resources (eg, MHPs lack of time); knowledge (eg, interactions around smoking that did occur were ill informed); social influences (eg, smoking norms within social network); and intentions (eg, MHPs lack positive intentions to deliver support). Enablers mainly fell within the domains: environmental context and resources (eg, use of appropriate support materials) and social influences (eg, pro-quitting social norms).ConclusionsThe importance of overcoming competing demands on staff time and resources, the inclusion of tailored, personalized support, the exploitation of patients wider social support networks, and enhancing knowledge and awareness around the benefits smoking cessation is highlighted.ImplicationsIdentified barriers and enablers represent targets for future interventions to improve the support of smoking cessation in mental health settings. Future research needs to examine the perceptions of the carers and family/friends of patients in relation to the smoking behavior change support delivered to patients.
Highlights
Evidence-based smoking cessation and temporary abstinence interventions to address smoking in mental health settings are available, but the impact of these interventions is limited
IMPLICATIONS Identified barriers and enablers represent targets for future interventions to improve the support of smoking cessation in mental health settings
Among individuals with a common mental health condition in England, smoking prevalence is over 50% 3, compared to 14% in the general population 4, and this difference increases further for more severe mental health t conditions 5. rip While the number of smokers in the general population has been steadily declining over c recent decades 6, the number of people with mental health conditions who smoke have not s been declining at the same rate 7
Summary
The health care system and the respective development and implementation of tobacco control policies can vary substantially across countries 20 These differences may present various contextual, political, and economic barriers that may impact on the success of quitting behaviours that require separate consideration. There are considerable differences t between settings in regard to quitting behaviours and type of support used Such variation rip reflects the differences in tobacco control implementation, the capacity of the country and the priority given to specific policies (for example, regulatory measures and the provision of c cessation support) 22. Some are non-modifiable (e.g. pharmacist’s behavioural control of Areconciling medications) 27, whilst others are modifiable (e.g. accessibility to smoking cessation interventions) 28
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