Jude Robinson

Smoke-free homes: what are the barriers, motivators and enablers? A qualitative systematic review and thematic synthesis

Objective To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs). Design Systematic review and thematic synthesis. Data sources Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists. Study selection We included 22 articles, reporting on 18 studies, involving 646 participants. Inclusion criteria: peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants’ perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH. Data extraction 1 of 3 authors extracted data with checking by a second. Data synthesis A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities. Conclusions This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs. Trial registration number CRD42014014115.

Get into Reading as an intervention for common mental health problems: exploring catalysts for change

There is increasing evidence for the efficacy of non-medical strategies to improve mental health and well-being. Get into Reading is a shared reading intervention which has demonstrable acceptability and feasibility. This paper explores potential catalysts for change resulting from Get into Reading. Two weekly reading groups ran for 12 months, in a GP surgery and a mental health drop-in centre, for people with a GP diagnosis of depression and a validated severity measure. Data collection included quantitative measures at the outset and end of the study, digital recording of sessions, observation and reflective diaries. Qualitative data were analysed thematically and critically compared with digital recordings. The evidence suggested a reduction in depressive symptoms for Get into Reading group participants. Three potential catalysts for change were identified: literary form and content, including the balance between prose and poetry; group facilitation, including social awareness and communicative skills; and group processes, including reflective and syntactic mirroring. This study has generated hypotheses about potential change processes of Get into Reading groups. Evidence of clinical efficacy was limited by small sample size, participant attrition and lack of controls. The focus on depression limited the generalisability of findings to other clinical groups or in non-clinical settings. Further research is needed, including assessment of the social and economic impact and substantial trials of the clinical effectiveness and cost-effectiveness of this intervention.

Volunteered, negotiated, enforced: family politics and the regulation of home smoking

The protection of children from secondhand smoke in their homes remains a key objective for health agencies worldwide. While research has explored how parents can influence the introduction of home smoking restrictions, less attention has been paid to the role of wider familial and social networks as conduits for positive behaviour changes. In this article we explore how people living in Scotland have introduced various home smoking restrictions to reduce or eliminate childrens exposure to tobacco smoke, and how some have gone on to influence people in their wider familial and social networks. The results suggest that many parents are willing to act on messages on the need to protect children from smoke, leading to the creation of patterns of smoking behaviour that are passed on to their parents and siblings and, more widely, to friends and visitors. However, while some parents and grandparents apparently voluntarily changed their smoking behaviour, other parents found that they had to make direct requests to family members and some needed to negotiate more forcefully to protect children, albeit often with positive results.

Reading between the lines: the experiences of taking part in a community reading project

Despite the popularity of reading groups, and the increased number of general-practitioner-referred bibliotherapy schemes in the UK, there has been relatively little research on the effects of reading works of literature on the well-being and health of readers. This paper reports the findings of a study set up to explore people’s experiences of taking part in community reading groups run by the Get into Reading Project in Wirral, Merseyside, UK. A qualitative approach was adopted, using three methods. These were participant observation with five reading groups, a key stakeholder interview and, with a sixth group, a single case study that consisted of observation and interviews with group members. The fieldwork conducted with the six groups took place in a variety of settings, including libraries, a residential drug rehabilitation unit and a hostel for homeless men. The research participants were all over 18 years of age, and all were members or facilitators of Get into Reading reading groups. The data were analysed thematically using NVivo qualitative analysis software. The findings show that the groups do not have a specific, targeted, therapeutic function, their primary purpose being more broadly literary, with literature itself trusted both to serve a coalescing social purpose and to offer non-specified but individual therapeutic benefits. Further work should be undertaken to explore the social and therapeutic benefits of reading literature in community settings.

Electronic cigarette use and risk perception in a Stop Smoking Service in England

Abstract Introduction: Electronic cigarette (e-cigarette) use rose substantially within the UK in recent years but currently, Stop Smoking Services in England do not prescribe them due to a lack of regulation. Previous research has examined e-cigarette use and attitudes within English Stop Smoking Services using samples of practitioners and managers; the current study recruited a sample of service users. Methods: Participants (N = 319) aged 18–60 years old were recruited from Roy Castle FagEnds, Liverpool, England (Stop Smoking Service). A cross-sectional questionnaire was completed, which recorded demographic variables, e-cigarette use alongside risk perception, and lastly, smoking behaviour i.e. smoking duration, cigarettes per day, and nicotine dependence. Results: Most participants were female (57.1%), current smokers (53.0%), and current or former e-cigarette users (51.7%). Participants who perceived e-cigarettes as less harmful than smoked tobacco were more likely to have smoked fewer cigarettes per day (p = 0.008). Furthermore, those who felt uncertain whether e-cigarettes were safer than smoked tobacco, were less likely to have tried them (p < 0.001). Conclusion: This study suggests that e-cigarette use is becoming common among users of Stop Smoking Services (despite e-cigarettes being unavailable from such services) and that e-cigarette risk perception is related to e-cigarette status. The results highlight the importance of providing smokers intending to quit smoking with current and accurate e-cigarette information. Findings may inform future Stop Smoking Services provision and the results demonstrate that further research is warranted.

Long-term access to support for people with sight loss

The impact of sight loss on everyday life changes over time, through further deterioration of vision, as well as a result of other physical changes and key events in people’s lives. As such, even the support needs of people with relatively stable visual impairment are likely to change throughout their life course. This article explores the long-term support needs of people with sight loss and the barriers they face when accessing services over time and at the time of need. Data from biographical interviews with 36 participants with sight loss is presented, with particular focus upon three illustrative case studies. The study reveals that many participants experienced problems gaining information about, and access to, services in the short and longer term. There is a need for systematic referral from clinical services to social and voluntary services and for regular follow-up to identify and respond to people’s changing needs.

Parental smoking and children's anxieties: an appropriate strategy for health education?

While the prevalence of smoking has declined in the UK in recent years, class differentials in smoking behaviour have become more marked and smoking is increasingly recognised as a causal factor in inequalities in health. Health education initiatives to support both smoking cessation and to teach children about the health risks of smoking remain key initiatives in reducing health inequalities. However, teaching children about the risks of smoking and the impact of parental smoking on their health is not straightforward for children from backgrounds who are more likely to encounter smoking at home and in their local communities. These children have to reconcile the key messages taught at school and reinforced in smoking cessation campaigns with the knowledge that their parents and other family members smoke. In this article we consider how children from smoking homes make sense of these education and health campaigns as observed by their parents, and the impact that this has on both parental smoking and relationships within the home. The article thus seeks to challenge assumptions about the delivery of health education and the need to acknowledge family diversity.

Using Focus Groups

Planning and delivering an effective and enjoyable focus group discussion requires researchers to consider not only issues of sampling and group composition, but group ethics and dynamics as well as the comfort and convenience of the research participants. The success of a focus group relates to the stimulation and engagement of the participants, and moderators need to work hard to develop topic guides and to introduce topics appropriately to ensure that participants are able to contribute to the discussions as fully as possible. Through a careful consideration of the research literature on the good practice of face-to-face and online focus groups, in this chapter I identify issues relating to their planning and delivery, and highlight some of the technical, methodological and analytical challenges researchers are likely to encounter.

Laughter and forgetting: using focus groups to discuss smoking and motherhood in low‐income areas in the UK

This article considers previously ignored aspects of verbal communication, humor and laughter, as critical components of social interaction within group discussions. Drawing on data from focus groups, Robinson uses a feminist perspective to explore how mothers living in areas of poverty in Liverpool, UK, use humor and laughter to discuss their experiences of smoking and caring for children. While laughter enabled some women to talk about sensitive and private issues, humor was also used by some women as a form of control, that is, to depress pretension in other women, to direct the flow of the discussion and to prevent the raising of ‘uncomfortable’ issues around their failure to prevent their children’s exposure to the health risks associated with breathing tobacco smoke. Robinson concludes with a discussion of how humor and laughter affected the dynamics of the groups and transformed the ‘neutral’ role of the moderator.

Developing a European urban health indicator system: results of EURO-URHIS 1

Introduction More than half of the worlds population now live in cities, including over 70% in Europe. Cities bring opportunities but can be unhealthy places to live. The poorest urban dwellers live in the worst environments and are at the greatest risk of poor health outcomes. EURO-URHIS 1 set out to compile a cross-EU inventory of member states use of measures of urban health in order to support policymakers and improve public health policy. Following a literature review to define terms and find an appropriate model to guide urban health research, EURO-URHIS Urban Areas in all EU member states except Luxembourg, as well as Croatia, Turkey, Macedonia, Iceland and Norway, were defined and selected in collaboration with project partners. Following piloting of the survey tool, a the EURO-URHIS 45 data collection tool was sent out to contacts in all countries with identified EUAs, asking for data on 45 Urban Health Indicators (UHI) and 10 other indicators. 60 questionnaires were received from 30 countries, giving information on local health indicator availability, definitions and sources. Telephone interviews were also conducted with 14 respondents about their knowledge of sources of urban health data and barriers or problems experienced when collecting the data. Most participants had little problem identifying the sources of data, though some found that data was not always routinely recorded and was held by diverse sources or not at local level. Some participants found the data collection instrument to not be user-friendly and with UHI definitions that were sometimes unclear. However, the work has demonstrated that urban health and its measurement is of major relevance and importance for Public Health across Europe. The current study has constructed an initial system of European UHIs to meet the objectives of the project, but has also clearly demonstrated that further development work is required. The importance and value of examining UHIs has been confirmed, and the scene has been set for further studies on this topic.