Development of a Smoke-Free Homes Intervention for Parents: An Intervention Mapping Approach.

Rachel O'Donnell,Stephen Turner,Marijn De Bruin,Lorna Booth,Sean Semple,Ruaraidh Dobson

doi:10.5334/hpb.20

Rachel O'Donnell, Stephen Turner + Show 4 more

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https://doi.org/10.5334/hpb.20

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Abstract

Exposure to second-hand smoke (SHS) is associated with various ill-health outcomes for children and adults. Barriers to creating a smoke-free home (SFH) are well-documented. Feasible and effective interventions to create smoke-free homes for disadvantaged households are lacking. Interventions that include providing parents with objective information about the impact of smoking on air quality in their home may be particularly effective. This study describes the development of a novel, theory- and evidence-based smoke-free homes intervention using objectively-assessed air quality feedback. The intervention was developed using the six-step Intervention Mapping (IM) protocol. Findings from literature reviews, focus groups with parents, interviews with health/care professionals, and expert panel discussions shaped intervention content and materials. Findings highlighted the importance of parents receiving personalised information on second-hand smoke levels in their home. Professionals considered the use of non-judgemental language essential in developed materials. Previous literature highlighted the need to address home smoking behaviour at a household rather than individual level. The AFRESH intervention is modular and designed to be delivered face-to-face by healthcare professionals. It includes up to five meetings with parents, two sets of five days’ air quality monitoring and personalised feedback, and the option to involve other household members in creating a smoke-free home using educational, motivational, and goal setting techniques. Further research is needed to evaluate the acceptability and effectiveness of the AFRESH intervention and which specific groups of parents this intervention will most likely benefit. IM was a useful framework for developing this complex intervention. This paper does not present evaluation findings.

Highlights

Exposure to second-hand smoke is associated with a widerange of preventable, adverse health outcomes in infants, children and adults
Living circumstances seem to have a major impact on the reduction of second-hand smoke in the home; for example, living in a block of flats and being unable to leave the children alone to go outside to smoke
The key factors identified as reasons for smoking indoors during the Step 1 needs assessment work are displayed in a logic model of the problem

Summary

Introduction

Exposure to second-hand smoke is associated with a widerange of preventable, adverse health outcomes in infants, children and adults. Fifteen percent of children living in the most deprived areas of Scotland are exposed to second-hand smoke in their homes, compared to close to zero percent of children living in the least deprived communities (Scottish Government 2016). Alongside this widening inequality in exposure, children in poorer communities in countries where smoke-free laws are partial or poorly enforced have seen almost no improvement in exposure levels. More than eighty-five percent of second-hand smoke is invisible (Gee et al 2013), and recent work has shown that secondhand smoke remains in household air for up to five hours after a cigarette is extinguished (Semple & Latif 2014). Most smokers try to protect their children from secondhand smoke, often applying strategies that reduce rather than eliminate second-hand smoke risks completely, such as smoking at the kitchen window, or only smoking in the house when children are absent (Wilson et al 2013a; Wilson et al 2013b)

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