Exploring Patient Perspectives on Tobacco Dependency Management: a Comparative Thematic Analysis of Physical and Mental Health Inpatients'

Abstract

Those with mental health conditions are more likely to smoke compared to the general population, contributing to the tento- twenty-year gap in life expectancy between these groups. This disparity highlights a major ongoing health inequality in the UK today. To help better understand this, so effective interventions can be developed to reduce this inequality, inpatients identified as active smokers from neighbouring physical health (Whittington Hospital), and mental health (Highgate Mental Health Centre) care settings took part in semi-structured interviews, exploring their past experiences with managing tobacco dependency (TD) and attitudes towards current smoking practice, including reasons for declining a referral to tobacco dependency specialist (TDS). Handwritten notes were taken during interviews and data analyzed using thematic analysis as meaningful text was inductively coded by the author, creating 'lower order' themes, identifying significant broader patterns in the data. Constant iteration of the data set grouped these into final 'higher order' themes, summarizing the data from both physical and mental health patient interviews. Definitions were given to each named theme, telling the story of the data and allowing comparison between the two cohorts' responses (see figure 1 for the data generated from interviews with patients in mental health setting). Results showed both groups cited the primary focus was their primary physical or mental health issue and so did not see smoking cessation as a priority to address. Both groups also used smoking as a perceived benefit, especially the physical health patients who cited smoking as a coping mechanism when dealing with the stress of being unwell. Re-framing the narrative for patients away from support to help them stop smoking, towards managing nicotine withdrawal whilst on smoke-free premises, may increase uptake in NRT or TDS support and aligns with the new BTS guidance on managing TD. Mental health patients have a much more complex relationship with tobacco dependence, meaning they are likely to require more intensive and prolonged support to increase the chances of sustained quit attempts. The funding of onsite TDS would be vital in supporting patients with this, inkeeping with the new BTS framework. (Figure Presented).