Smoke Exposure Disclosure: Parental Perspectives of Screening in the Inpatient Setting
Brian S Williams1,2,3, Carrie Nacht4, Michael C Fiore2,3
1Departments of Pediatrics bswilliams@wisc.edu.
Insights
Pediatric tobacco smoke exposure screening is suboptimal. Parents identified facilitators like perceived relevance and positive questioners, but barriers like fear and vague questions hinder accurate disclosure.
Area of Science:
- Pediatric Health
- Environmental Health
- Qualitative Research
Background:
- Current screening for pediatric tobacco smoke exposure is suboptimal.
- Factors influencing screening accuracy in pediatric inpatient settings are not well understood.
Purpose of the Study:
- Identify facilitators and barriers to parental disclosure of smoke exposure during pediatric hospitalization.
- Determine strategies to promote accurate disclosure.
Main Methods:
- Qualitative study using semistructured interviews with parents of hospitalized children.
- Convenience sample from a Midwest tertiary care children's hospital.
- Analysis of parent experiences with inpatient pediatric smoke exposure screening.
Main Results:
- Facilitators included caregiver characteristics, perceived relevance to child's health, and positive questioner interactions.
- Barriers comprised fear of consequences, vague questions, lack of knowledge, guilt, and poor environment/timing.
- Suggested strategies involved preemptive communication, specific examples, improved rapport, and better environment/timing.
Conclusions:
- Parents offered actionable insights to enhance tobacco smoke exposure screening.
- Addressing identified barriers and leveraging facilitators can improve inpatient pediatric screening accuracy.
Objectives:
Current screening questions for pediatric tobacco smoke exposure are suboptimal. Factors influencing screening accuracy, particularly in the pediatric inpatient setting, are unknown. Our objective was to identify facilitators of and barriers to parental disclosure of smoke exposure when screened during their child's hospitalization and strategies to promote accurate disclosure.
Methods:
This qualitative study was conducted with a convenience sample of parents of children admitted to the medical and surgical unit of a Midwest tertiary care children's hospital. Eligible parents included those with documented disclosure of smoke exposure in the child's electronic health record. A researcher trained in qualitative methods conducted semistructured, in-depth interviews with parents regarding their experiences with smoke exposure screening in the inpatient pediatric setting. Two researchers independently identified concepts directed at barriers, facilitators, and strategies for effective screening, which were compared and reconciled by a third researcher.
Results:
Facilitators of disclosing their child's smoke exposure included the following: (1) the caregiver's internal characteristic(s) promoting disclosure, (2) perceived relevance of the screening question to the child's health, and (3) the questioner being viewed positively. Barriers included the following: (1) fear of negative consequences, (2) a vague question, (3) lack of knowledge, (4) guilt, and (5) unconducive environment and timing. The strategies parents suggested to improve screening for smoke exposure included the following: (1) communicate preemptively, (2) provide specific exposure examples, (3) improve questioner-caregiver rapport, and (4) improve screening environment and timing.
Conclusions:
Parents identified various mechanisms to improve tobacco smoke exposure screening. The facilitators, barriers, and strategies provide opportunities to improve the inpatient pediatric screening process.
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