D2.142 - Smoking cessation advice to parents in children with bronchial asthma- still it is a long way to go

Smoking cessation is one of the most important interventions while managing children with asthma. Successful smoking cessation is associated with reduced frequency of asthma exacerbations.

This qualitative study examines parents' perspectives and opinions on the quality of smoking cessation advice provided in primary and secondary care. Such insights may influence the long-term effectiveness of these interventions. 

We conducted this qualitative study as part of a clinic-based initiative aimed at effective smoking cessation. After obtaining verbal consent, we interviewed fifteen parents of children with a confirmed diagnosis of asthma who smoke. The selection of participants was opportunistic, and we included only those parents who were willing to discuss smoking cessation advice in detail. The interview data was thematically analysed to reach the outcome.

None of the parents received the Precaution Adoption Model (PAM) intervention, which includes Motivational Interviewing to provide feedback on their child's exposure to second-hand smoke along with cessation induction strategies. Additionally, the Behavioural Action Model intervention, which focuses on goal setting and cessation strategies, was also not utilized. The discussions in both primary and secondary care were unstructured and rushed, leading to casual smoking cessation advice in both settings.

All parents expressed a universal feeling of guilt, along with sentiments of blame and shame, and reported feeling unsupported. They perceived a lack of empathy and understanding from healthcare workers, who compelled them to follow smoking cessation advice without addressing the underlying reasons behind their smoking habit, which for many was stress. Parents believed that if they received adequate support to manage their stress and were allowed to discuss the reasons behind their smoking, the smoking cessation advice would be more effective.More than half of parents felt responsible for their children's hospital admissions, believing that their smoking was the main cause of the child's condition, which heightened their guilt. Despite this, many saw it as a chance to motivate themselves to quit smoking. 

Parents found web-based resources helpful, but preferred information from healthcare practitioners. There was a notable lack of motivational interviewing in secondary care outpatient settings due to limited contact time between providers and families.Additionally, parents stated that pediatricians often had limited knowledge of various smoking cessation strategies, as they commonly believe “children don’t smoke.”

This study highlights key areas for improving smoking cessation advice effectiveness. Limited training among healthcare professionals (HCPs) in primary and secondary care may hinder discussions with parents, leading to defensiveness from a perceived lack of empathy. Factors such as time constraints, insufficient structured training, and language choice can result in suboptimal smoking cessation advice, which is vital for paediatric asthma management.