A Systematic Review of Mental Health Professionals, Patients, and Carers’ Perceived Barriers and Enablers to Supporting Smoking Cessation in Mental Health Settings

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. Therefore, this review aimed to identify and synthesise the perceived barriers and enablers to supporting smoking cessation in mental health settings. Method 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 (TDF), Key barriers and enablers were identified through the combining of coding frequency, elaboration, and expressed importance. Results Of thirty-one 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 (e.g. MHPs lack of time); knowledge (e.g. interactions around smoking that did occur were ill-informed); social influences (e.g. smoking norms within social network), and intentions (e.g. MHPs lack positive intentions to deliver support). Enablers mainly fell within the domains: environmental context and resources (e.g. use of appropriate support materials) and social influences (e.g. pro-quitting social norms). Conclusion The importance of overcoming competing demands on staff time and resources, the inclusion of tailored, personalised support, the exploitation of patients wider social support networks, and enhancing knowledge and awareness around the benefits smoking cessation is highlighted. Implications Identified 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 behaviour change support delivered to patients.

Effectiveness of Mental Health Warnings on Tobacco Packaging in People With and Without Common Mental Health Conditions: An Online Randomised Experiment

“…Many people also describe using smoking as a method to “self-medicate” mental health symptoms, such as depression or anxiety ( 19 , 27 , 62 ). This view is persistent among many populations, including health professionals ( 20 , 21 ). Therefore, the MHWLs contradict peoples’ current understanding of the effects of smoking, and the effects of smoking on mental health are not well understood.…”

“…There is an extensive range of physical health risks portrayed on tobacco health warning labels in the UK and internationally (16), which are demonstrated to be effective in promoting smoking cessation, and reducing smoking uptake (14,17,18). However, it is less well known amongst the general public and healthcare professionals that smoking can negatively affect mental health (19)(20)(21). A large body of evidence suggests that tobacco use increases the risk of developing depression, schizophrenia and bipolar disorder (22)(23)(24)(25), and that smoking cessation can reduce symptoms of depression, anxiety, and stress, and lead to improved wellbeing and positive feelings (26).…”

Nurses’ Perspectives on Smoking Policies, Safety and Cessation Support in Psychiatric Wards: A Cross-Sectional Survey

“…On the other hand, high smoking rates in mental health settings constitute a smoking culture with “a long and entrenched history” [ 17 ], which affect healthcare professionals through peer pressure, and inevitably influence psychiatric patients through role modelling. It was pointed out that frequent observations of smoking professionals and other patients challenged patients’ own attempts to quit this unhealthy habit [ 51 ].…”

“…Unfortunately, Prochaska (2011) reported that smoking cessation interventions are still not offered often enough to patients in mental health facilities [ 54 ]. A recent review reported that the lack of awareness among healthcare professionals regarding links between tobacco use and mental illness remains a serious barrier to the provision of smoking cessation support [ 51 ]. Prochaska (2010) argued that smoking, contrary to professional belief, does not help relieve negative mental health symptoms, and is actually associated with increased depressive symptoms and suicidal risk behaviours [ 55 ].…”

Promoting and Maintaining Changes in Smoking Behavior for Patients Following Discharge from a Smoke-free Mental Health Inpatient Stay: Development of a Complex Intervention Using the Behavior Change Wheel

“…These were then coded to the domains of the COM-B and TDF. The detailed methods are published elsewhere 25 .…”