Workplace factors: The key to successful and sustained continuation of a general practice-based smoking cessation programme

Abstract

Health promotion activity such as smoking cessation is now expected in primary care settings, including general practice. However, successful implementation and continuation of health promotion programmes is often difficult to achieve in any consistent way across a locality. This study aimed to investigate factors associated with implementation and maintenance difficulties for a smoking cessation programme in primary care, despite the provision of well-received training and support for practice nurses and general practitioners. A descriptive evaluation using numerical data and semi-structured interviews was used for general practices in the Wellington region of New Zealand during 2001-2002. The Can Quit Practice smoking cessation programme was developed and made available to all 114 general practices in the Wellington area. Data were collected and interviews conducted about implementation and ongoing programme delivery. One-third (39/114, 34%) of practices accepted and completed training for at least one staff member, usually a practice nurse. Subsequently, only 44% of practices (17/39) went on to achieve full programme implementation. Key factors precluding implementation included inadequate funding for practice nurse and general practitioner time, high patient workloads, lack of practice nurse autonomy and limited practice-wide commitment to smoking cessation. Unfavourable workplace factors can preclude the successful implementation and maintenance of an effective smoking cessation programme for patients, even when health professionals are aware of the benefits of smoking cessation, recognise the worth of offering such programmes, and receive acceptable training and ongoing support at no cost.