Table 5 Factors influencing clinical behaviors related to tobacco counseling among PED/UC professionals overall and by professional group: emotion, beliefs about consequences, and goals TDF domains
TDF domain | Sub-theme | Professional group | Sample responses | ||
|---|---|---|---|---|---|
Nurse | Physician | Administrator | |||
Emotion | Sensitive topic to discuss with parents | ✓ | ✓ | ✓ | “A lot of times in the ER, parents are having the worst day and they already have a lot going on. Most of them want the best for their children. So, it doesn’t always feel like the right time to bring up telling them to stop dealing with the habit they have that helps them deal with their stress.” — Nurse |
Stressed to complete tasks during visit | ✓ | ✓ | ✓ | “Clinic flow in the ER is nuts. It’s paramount, right? You often have patients waiting for six hours to be seen and be coming for a completely different problem. Spending too much time on something that is not specifically focused on their chief complaint is a no-no. Time is a precious resource in the ER, so we have to be very efficient in order [for it] to be widely implemented.” — Administrator | |
Beliefs about consequences | When discussing tobacco use and TSE, parents might feel defensive | ✓ | ✓ | ✓ | “We don’t want people to be defensive. We are constantly drilled about patient satisfaction and so it’s hard to have those conversations when it feels confrontational, and then you don’t want them to be upset with you or damage the relationship that you have with a parent. I only address it if it seems like they would be willing to listen or if it seems to be maybe [a] part of the cause of the problem… but other than that I typically don’t say a lot.” — Nurse |
Think that not addressing TSE will result in decreased child health and increased repeat visits or hospitalizations | ✓ | ✓ | ✓ | “If you don’t intervene and get buy in from them and get some commitment to change, you may lose the opportunity to improve their overall clinical picture... potentially lead[ing] to decreased need for accessing the health care system [and] decreased exacerbations for asthma if that’s what they’re there for. I see it as missed opportunities to improve their overall healthcare picture.” — Physician | |
Think that not addressing TSE will reduce the likelihood for parents to quit smoking and in turn children remain exposed and may become smokers themselves | ✓ | ✓ | - | “If you’re exposed to stuff in your household, you think it’s okay. Then you grow up doing it as well, so the pattern just kind of continues.” — Nurse | |
Goals | Discussing tobacco counseling with parents using a standardized approach is important | ✓ | ✓ | ✓ | “I definitely think there needs to be some sort of standardized information that you would go through so that it is being presented the same across all boards.” — Physician |