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Title: Explanations of high smoking prevalence and suboptimal lifestyle behaviours among people with severe mental illness : a systems approach
Author: Trainor, Katie
ISNI:       0000 0004 6494 3753
Awarding Body: Ulster University
Current Institution: Ulster University
Date of Award: 2018
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People with severe mental illness (PWSMI) die 10-25 years earlier than people in the general population and this is often due to preventable smoking-related medical conditions. This study aims to explore explanations of high prevalence of smoking and suboptimal lifestyle behaviours among PWSMI from a systems perspective, to assist in the development of a feasible intervention. Furthermore, broad-based tobacco control strategies and generic cessation interventions have not been evaluated among PWSMI. Currently, there is a lack of literature which explores the potential for a shared role of non-medical providers in the area of smoking cessation and lifestyle intervention. This study aims to explore the challenges experienced by voluntary sector care workers in delivering a universal smoking cessation intervention. This research adopted a qualitative methodology to gain a full and descriptive insight of smoking and suboptimal lifestyle behaviours among PWSMI through enabling participants to give a full account of their personal experiences. A grounded methodology was used to drive data collection and analysis. Semi structured interviews were carried out with eighteen service users and seven care workers. Two focus groups were also held with care workers from a second voluntary sector organisation. The second group was held twelve weeks after participants attended a smoking cessation training workshop. Findings suggested that service users consumed 15-60 cigarettes daily. However, they often expressed hopes of quitting and most had made previous quit attempts. Smoking behaviours can be explained by a number of factors. The pro-smoking culture within mental health settings appears to endorse and reinforce heavy smoking behaviours. Societal perceptions that smoking is a choice and beliefs that smoking and mental illness are intrinsically linked, poses significant barriers to cessation. Service users appeared to have internalised societal and cultural perceptions as smoking was deeply engrained in their everyday routines, interactions and identities. Systemic discrimination, such as reduced access to cessation support, meant that service users adopted maladaptive quitting strategies to quit. Furthermore, the data suggested that the generic stop smoking service intervention is unlikely to be suitable for this group. It needs to be adapted and tailored to meet the needs of PWSMI. Service users neglect their physical health, and comorbid physical health problems were common among participants. Most service users led sedentary lifestyles and had poor dietary patterns. Heavy smoking and suboptimal lifestyle behaviours among PWSMI are a result of complex lifestyle, sociological, systemic and cultural barriers to cessation. Moreover, barriers at different levels were related and they reciprocally affected one another. It is essential that clearer policy is developed and disseminated, detailing responsibilities for lifestyle intervention for PWSMI. Further, all multidisciplinary staff who have contact with service users should be involved in smoking cessation training. This is critical to increase access to interventions, alter the cultural and societal acceptability of smoking among PWSMI and to address the high rates of smoking and premature mortality.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available