Practice nurses’ adherence to smoking cessation guidelines and needs for web-based support: a needs assessment

Abstract

Background. Dutch practice nurses sub-optimally adhere to evidence based smoking cessation guidelines, but psychosocial determinants explaining their adherence have not yet been investigated. Online interventions could improve guideline adherence by providing personal advice tailored to adherence determinants. This study explored psychosocial determinants of practice nurses’ adherence to smoking cessation guidelines and their needs for online adherence support. Methods. Semi-structured individual interviews (N=19), based on the I-Change Model and The Diffusion of Innovations Theory, with practice nurses were conducted in May-September 2014. Data was systematically analysed using the Framework Method and considered reliable (Kappa .77; percent agreement 99%). Results from these interviews were used as input for a questionnaire, aimed to quantify the impact of the identified psychosocial determinants among a large group of Dutch practice nurses (N=157). Findings. Practice nurses reported motivational (e.g. difficulties enhancing patient motivation and conducting follow-up consultations) and practical barriers (e.g. outdated information on quit support compensation) to smoking cessation guideline adherence. All respondents reported to use a guideline and 89% were interested in online adherence support. Quantitative results confirmed practice nurses’ suboptimal guideline adherence, and revealed that self-efficacy (e.g. to counsel non-Dutch and low educated smokers) and perceived advantages (e.g. enhancing smokers’ awareness and providing reliable information) were important determinants for their adherence. Discussion. Addressing practice nurses’ motivational and practical barriers via a tailored online adherence support program can potentially improve their smoking cessation guideline adherence, ultimately benefitting the quality of smoking cessation care in Dutch general practices.