Primary care healthcare professionals’ knowledge, attitudes and practices towards promoting the reduction of children’s secondhand smoke exposure: a mixed-methods review and synthesis

Introduction
Secondhand smoke exposure (SHSe) leads to increased mortality and morbidity. Primary care healthcare professionals (HCPs) are well-placed to support patients to reduce SHSe. This paper explores HCPs’: (i) knowledge around SHSe; (ii) current practices to promote SHSe reduction; (iii) beliefs and experiences regarding delivering interventions to reduce SHSe; and (iv) identified factors that influence the delivery of SHSe-related interventions.

Methods
Six electronic databases were searched for relevant literature published January 1980 - February 2016. 17 quantitative and 3 qualitative studies were included in this mixed-methods review. Data synthesis followed the method outlined by the Joanna Briggs Institute. This segregated approach involved independent syntheses of the quantitative and qualitative data followed by an overall mixed-methods synthesis.

Results
Primary care HCPs had a basic understanding of the risks associated with SHSe but required training to help them intervene. It was more common for HCPs to ask about SHSe or provide advice than to act to facilitate SHSe reduction. SHSe was viewed as an issue of high importance and considered relevant to the role of the primary care HCPs. However, barriers such as the priority given to the issue and the desire to protect the professional relationship with patients, prevented HCPs from intervening around SHSe.

Conclusions
Primary care HCPs require training, guidance and support to enable them to intervene and support patients to effectively reduce SHSe.

IMPLICATIONS
This review used rigorous methods to explore the current, global literature on how children’s exposure to secondhand smoke is being addressed in primary care settings. The review findings highlight healthcare professionals’ need for further training and support, which would enable them to better translate their knowledge of the risks associated with secondhand smoke exposure into actual clinical practices. The review identified a lack of practical action taken to address secondhand smoke exposure, even once it has been identified as an issue.