The Relationship Among Predisposing and Enabling Factors or Barriers in Nurses Provision of Tobacco Control Interventions

Abstract

The control o f tobacco use. the single most preventable cause o f disease in the U.S., is a national health priority. An estimated 70% o f smokers desire to quit; however, only 7% who quit remain abstinent one year later. It is recommended that all clinicians assess and document smoking status as the fifth vital sign. There is a demand for nurses, comprising the largest discipline of health care providers, to systematically incorporate tobacco control clinical practice guidelines in their practice as a means to lower tobacco related disease morbidity and mortality. There is a paucity o f knowledge on (a) the extent to which RNs deliver tobacco control interventions, (b) their educational preparation in tobacco control, and (3) factors that are associated with nurses tobacco control interventions. The purpose o f this study was to determine the relationship among predisposing factors and enabling factors or barriers in recently licensed registered nurses’ delivery of tobacco control interventions. The Educational and Ecological Assessment phase o f Green and Kreuter's PRECEDE-PROCEED Model served as the theoretical framework underpinning this study. A descriptive correlational cross-sectional design was utilized. RNs who received initial licensure in Georgia during 1999.2000. and 2001 were sampled utilizing a probability sampling method, stratified random sampling, to obtain a sample size o f approximately 10% o f the population within each year of licensure. The final sample consisted o f 468 participants. Findings indicated nurses’ performance in tobacco control interventions (ask. advise, assess, assist, arrange) was low, with the average score being only 37%. Thirty-percent o f RNs provided no tobacco control interventions. The majority had received no clinical experiences in smoking cessation techniques (78%) or tobacco prevention (70%). Univariable analyses found attitudes, beliefs in the importance o f tobacco control, tobacco education, extent o f education in tobacco cessation techniques, use o f clinical practice guideline, perceived importance of tobacco policy, prevention interventions, and peer barriers were significantly associated (p<.05) with nurses delivery o f tobacco control interventions. Multiple regression analyses utilizing a general linear model found attitudes, belief in importance o f tobacco control, tobacco education, prevention interventions, peer barriers, and institution barriers (negative correlation) accounted for significant variances (p<.05) in the tobacco control intervention scores.