The impact of a social norms approach on reducing levels of misperceptions around smokefree hospital entrances amongst patients, staff, and visitors of a NHS hospital: a repeated cross-sectional survey study

Abstract

BackgroundSmoking is a cause of avoidable morbidity and mortality. In the United Kingdom (UK) the national smoking ban inside hospital buildings is widely adhered to. There is a perception it has led to smokers congregating around hospital entrances (Selbie D. 2016, It’s time for a truly smokefree NHS. Public Health Matters Blog. Public Health England). Efforts to shift social norms and create positive smokefree environments might be strengthened by delivering social norms messages. This study explored the impact of a social norms approach campaign to reduce levels of misperceptions surrounding support for smokefree hospital entrances.MethodRepeated cross sectional study design. Staff, patients, and hospital visitors at Pinderfields National Health Service (NHS) Hospital (Wakefield, United Kingdom (UK)) completed a survey before and after implementation of a public health social norms campaign (n = 481 surveyed before; n = 459 surveyed after). The main outcome measure was difference between perceived and reported levels of support for smokefree hospital entrances.ResultsThere were high levels of support for smokefree hospital entrances. The majority of participants agreed that patients (n = 849, 90% agreed), staff (n = 863, 92% agreed), and visitors (n = 850, 90% agreed) should not smoke in the hospital entrance.Participants underestimated the proportion of others who self-reported keeping the entrance smokefree. Over 90% of respondents reported not smoking in the hospital entrance, but the perception was that between 50 to 75% of hospital staff, patients, and visitors did not smoke in the hospital entrance.The mean percentage of hospital staff, patients, and visitors who respondents thought did not smoke in entrances was higher for respondents responding after, compared to those responding before, the campaign. There was an overall significant effect of time on attitudes towards smoking in the entrances; in all instances the mean percentage of hospital staff, patients, and visitors the participants believed agreed that hospital entrances should be smokefree was higher for those responding after, compared with before, the campaign.ConclusionsPeople hold misperceptions of the proportion of people who choose to smoke in the hospital entrance. The social norms approach campaign was associated with a strengthening of positive social norms. Such campaigns should be considered by Trusts as one evidence-based based tactic to denormalise smoking, increase support for smokefree policies.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6231-x) contains supplementary material, which is available to authorized users.

Health Professionals’ Views on Lifestyle Advice Delivery to Teenage and Young Adult Cancer Patients

“…This could be achieved through social norms-based interventions that have been shown to be effective at changing workplace culture toward smoking cessation. 30 Several TYA-HPs highlighted the lack of formal training they had received on health promotion and felt this topic should be included within undergraduate professional training and introduced as a core professional competency. This reflects growing acknowledgment that current medical, nursing, and allied health professional curricula need to be adapted to support health promotion.…”

“…Given that organizational culture and workplace culture are known to influence health promotion behavior in the United Kingdom, 16,29 efforts should be made to facilitate TYA-HPs to share best practices and garner support from colleagues to address health behavior as a routine task. This could be achieved through social norms–based interventions that have been shown to be effective at changing workplace culture toward smoking cessation 30 . Several TYA-HPs highlighted the lack of formal training they had received on health promotion and felt this topic should be included within undergraduate professional training and introduced as a core professional competency.…”

Hospital entrance smoking is reduced by broadcasting recorded antitobacco messages from Australian primary school children over entrance public address system

“…Creating smoke-free environments denormalises tobacco use and supports increased quitting, but the presence of smokers at a busy hospital entrance undermines this public health message. 9,[18][19][20] Our data indicated the broadcasts of children voicing smokefree messages made the entrance a less appealing environment for F I G U R E 2 Daily summary of cigarettes/hr (bars), nonsmoker movements (solid line) and daytime temperature smoking, but frequency of messaging was important for significant effect. The original study design had 5-minutely broadcast intervals, but this plan occurred before the recording workshop, and the final sound bites obtained were shorter than anticipated.…”

“…Debate may occur on the value of such projects that use children's voices to potentially shame and stigmatise unwell people who smoke in health care setting, particularly those where assessment and treatment of tobacco dependency is suboptimal. Most would agree that smoking in the shared environment of a hospital entrance smoking is highly undesirable and difficult to manage, [18][19][20] so further research on ways to minimise is worthwhile.…”

Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis

“…1 ). 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ,…”