disinclined to encourage tobacco use reduction or cessation [19]. Many practitioners lack confidence in their ability to provide smoking cessation counselling, and some are ambivalent or diffident in light of their own tobacco dependence perhaps because they do not see themselves as credible role models [20].
A survey of the staff of an English psychiatric hospital revealed that 60% of the staff believed that they should smoke with their patients, 54% believed that smoking had a therapeutic role, and 93% believed that their patients would deteriorate if access to cigarettes was banned [21]. Another UK study found that mental health nurses who smoked were more likely to report a positive value of smoking in the formation of therapeutic relationships and were less likely to believe that patients who smoke should be encouraged to cut back or stop [22].
Much of the relevant research has focussed on in-patient settings. Yet, the majority of people who require mental healthcare in Canada receive their care within the community. Given the unique attributes of Canada's publicly funded healthcare system, and Canada's tobacco control initiatives, it is important to consider the extent to which smoking reduction and cessation interventions have been incorporated into the Canadian mental health system. To address these gaps, this study was aimed at describing community-based mental healthcare providers’: (a) attitudes about tobacco use and confidence in providing effective smoking cessation intervention, (b) personal smoking status, and (c) incorporation of smoking cessation interventions into practice. In addition, we were interested in determining whether the providers’ attitudes, confidence, and smoking status influenced whether they assessed their clients’ smoking status and engaged in discussions about tobacco use with their clients.
2. Methods
A cross-sectional, self-administered questionnaire survey was used for this study.
2.1. Sample
The sampling frame included mental healthcare providers employed by Vancouver Community Mental Health Services’ eight community mental health teams and 14 contracted community agencies. A total population sampling strategy was employed in which all providers working at the designated agencies were recruited. Providers were defined as paid employees who provided direct services, including support and programming, to persons with SMI living in the community. Administrators and other non-direct care or specialized population service providers (e.g., geriatric, child, or adolescent services, emergency services) were excluded from the study. It was difficult to ascertain the exact number of employees at each agency (because of individuals working at multiple sites, high turnover rates, and poor employment records); it is estimated that the target population ranged between 750 and 871 providers.
The project staff visited each agency, provided detailed information about the study, distributed the questionnaires, and conducted several follow-up visits to answer questions about the study and to encourage participation. In order to increase the likelihood of participation, distribution strategies were tailored to suit the needs of each workplace setting. In some agencies project staff were able to directly distribute individual questionnaires through access to personal employee mailboxes. In other settings, an individual senior employee acted as a key contact point for the study and