The research literature suggests that clinicians fail to adequately use health education interventions that have been demonstrated to be effective. This thesis examines the use of smoking cessation education (SCE) by clinicians who care for pregnant women. It investigates the clinician, organisational and dissemination variables which impact on the provision of smoking cessation education in antenatal clinics. Individual behaviour change theory, organisational theory and diffusion theory are used to guide the design and analysis of the research. A series of cross-sectional studies are used to investigate the provision of SCE and the outcomes of dissemination of a tested SCE program. Data are collected from multiple sources and both qualitative and quantitative research methods are used. Studies 1 and 2 indicated there was a performance gap between the reported SCE practice of clinicians who provide care for pregnant women and the recommended guidelines for SCE practice. The primary modifiable barriers to the provision of SCE by clinicians were: low clinician self-efficacy with regard to SCE; inadequate smoking assessment; lack of hospital SCE policy; and inadequate training. To overcome these barriers a SCE program was disseminated to 23 hospital antenatal clinics in NSW. Prior to dissemination, the organisational context of the clinics was explored using qualitative methods to determine the potential barriers to dissemination and to recommend strategies to overcome these barriers (Study 3). The remaining Studies (4-6) describe the outcomes of program dissemination using two methods of dissemination (intensive and simple). Clinics were randomly allocated to the two dissemination methods. Studies 4 and 5 describe program adoption by clinic managers three months after the initial dissemination. Study 6 investigates the implementation and maintenance of the program by clinicians 18 months after dissemination. The final study also examines the effect of two methods of dissemination on the provision of SCE in antenatal clinics. Most managers adopted or partially adopted the new SCE program. The fidelity of program adoption was better when intensive dissemination methods were used and when managers had more positive perceptions of the program. Dissemination method did not affect the number of SCE interventions offered by clinics, but clinicians in the intensive dissemination group were more likely to use more intensive and effective forms of SCE intervention. Nevertheless, the program was poorly implemented and SCE was not systematically provided in clinics after dissemination. The organisational, individual and dissemination barriers to health education are described.

Thesis (M.Sc.)--Saint Mary's University, 2009. / Includes abstract and appendices. Supervisor: Steven Smith. Includes bibliographical references (leaves 58-62).

Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xiv, 147 p.; also includes graphics. Includes abstract and vita. Advisor: David Stein, College of Education. Includes bibliographical references (p. 98-103).

Thesis (M. Phil.)--University of Hong Kong, 2009. / Includes bibliographical references (leaves 194-209). Also available in print.

Thesis (M.Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 54-57).

Thesis (M. Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 170-178).

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

Background: Over the past ten years or so, there is a huge increase in the popularity of electronic cigarettes around the world. Some people regard e-cigarettes as a tobacco substitute and use them to help smoking abstinence and relieve nicotine withdrawal symptom. On the other hand, there are those who believe that e-cigarettes should not be promoted since safety and efficacy of these battery-operated devices are still under investigation. Hence, this project aims to evaluate the effect of using electronic cigarettes to quit smoking among the conventional smokers. Methods: This project used key words to search on PubMed, MEDLINE, The Cochrane Library, 中国知网(CNKI), EMBASE, and BBCNEWS. Eventually, a total of 111 items in PubMed, 6 in The Cochrane Library and 23 were obtained in CNKI. After the screening process, finally 11relevant papers were reviewed in this project. There were two randomized controlled trials on evaluating the effect of reducing smoking with e-cigarettes. Five surveys(Survey 1-5) analyzed users’ satisfaction and their original expectations on trying electronic cigarettes. Two proof-of-concept trials also assessed the effect of using e-cigarettes on reducing and quitting smoking. In addition, a qualitative study and a case series study provided evidence on interpreting whethere-cigarettes could help smoking abstinence. Results: Brown et al. 10conducted a RCT and showed that in an intention to treat analysis, combined ≥50% smoking reduction and complete smoking abstinence was shown in 33% (99/300) at 12 weeks and 19% (57/300) at 52 weeks. Another RCT conducted by Bullen et al. showed the continuous abstinence at 1 month was23.2%in nicotine e-cigarettes group and15.9%in nicotine patches group and 16.4%in placebo e-cigarettes group; at 3 month, the rateswere13.1%, 9.2% and 6.8%; at 6 months, the rates were 7.3%, 5.8% and 4.1%.In survey 1 (Etter), satisfaction of helping smokers quit was79%; in survey 2 (Kralikova et al.), satisfaction of helping quit was over 60%; in survey 3 (Dawkins et al. 14), participants reported their situation of smoking cessation: 38% for >1 year, 19% for 6-11 months, 43% for < 6months;in survey 4 (Etter and Bullen), 92% current smokers and 96%former smokers reported ECs were effective to reduce their smoking consumption; in survey 5 (B. Siegel et al. ), 66.8% smokers reported it helped quitting smoking. In two proof-of-concept trials, sustained quitting more than 50% including quitter accounted for 55% and 64.3%.Thequalitative study and the case series study indicated that ECs were modestly effective to reduce smoking consumption with less toxic effects. Conclusion: There is some preliminary evidence from11studiesthatelectronic cigarettes could be effective for reducing conventional smoking consumption within a short period. Because there is a lack of adequate and long-term randomized controlled trials to assess the safety and efficacy of e-cigarettes, particularly in comparison to nicotine replacement therapy, government regulations should be established to control e-cigarettes and to the claim that e-cigarettes can be used as a standard as nicotine smoking cessation aid. / published_or_final_version / Public Health / Master / Master of Public Health