Health Promotion for Tobacco Smoking Cessation

This article discusses the importance of health promotion in tobacco smoking cessation and the role of nurses in promoting health. It explores the challenges and opportunities in the community setting and highlights various models and approaches to health promotion. The article also emphasizes the need for primary, secondary, and tertiary prevention strategies in reducing smoking-related illnesses.

Running Head: HEALTH PROMOTION FOR TOBACCO SMOKING CESSATION
Health Promotion for Tobacco Smoking Cessation
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Health promotion for Tobacco Smoking Cessation
Introduction
Health promotion has become a vital aspect of the healthcare systems in the current
healthcare sector. Promoting healthy behaviours and lifestyles as well as the prevention of
diseases has moved to a forefront position in the field of healthcare (de Jong, Wagemakers &
Koelen, 2019). According to the World Health Organization, health promotion is described as
the process that allows individuals to enhance control over the health determinants and
consequently enhance their health. Promoting wellness as well as creating strategies including
confrontation of barriers and obstacles to wellness has been integrated into the nursing practice.
Health professionals have the mandate and responsibilities to promote health at the community,
group and individual levels. Being one of the largest groups of healthcare professionals, nurses
have the ability, and potential to effectively contribute in the area of health promotion.
It should be noted that nurses are normally at the forefront of the healthcare sector since
they are one of the largest healthcare occupations not only in Ireland but also in other countries
of the world (Turner, 2014). Nurses are the most visible and conspicuous healthcare profession
due to their large numbers as well as the amount of time they usually spend with individuals,
friends and family (Abou El Fadl, Blair & Hassounah, 2016). Moreover, nursing has a role in the
promotion of health not only because nurses are conspicuous but are also anchored on advanced
education. It should be noted that nursing is considered as a profession which provides advanced
education via three various pre-licensure tracts. There has been a spirited and longstanding
request for community healthcare nurses to incorporate and adopt both health educational and
promotional activities into their programs. This paper will critically discuss how nurse or

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midwife can apply the models and approaches to the promotion of health to the healthcare setting
for tobacco smoking clients. The paper will discuss health promotion opportunities, challenges
and barriers to promoting health.
Background information
Globally, primary care is acknowledged as the most effective and appropriate way to
offer healthcare services as it offers high quality easily accessible services for the local
community in a prompt and timely manner (Schroepfer, 2016). The progress of primary care has
shown positive results in terms of targeting population and individual health needs. There have
been numerous developments in primary care in Ireland since the unveiling of primary care like
the unveiling of the primary care teams. Nationally, primary care teams operate together to
deliver locally, accessible social and health care services to a known or defined target population.
Public health nurses in Ireland play a vital role in primary care teams because of their generic
function and role (Hanafin, 2018). Nevertheless, there are normally numerous opportunities as
well as challenges as part of primary care teams. There is a great deal of debate within the
healthcare literature concerning how health behaviour of a nurse and consequently his or her
ability in nursing associates with the promotion of health. Empirical researchers have studied
nurse’s health behaviours, and their findings show that nurses normally do not take part actively
in healthy behaviours. Thus, many nations like Ireland, have incorporated health promotion into
nursing practice (Eckermann, 2016).
It should be noted that numerous nursing-related studies have tried to pinpoint specific
issues on the extent, role, and nature of activities of health promotion within the community
settings. Each study has examined various facets of the health promotion strategy observed in

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various community-based nursing groups. Much of the research has presented contradictory
findings. Thus, it is hard to establish as well as verify a universal stand on the exact nature and
state of health promotion activities in local and community environment.
Health promotion for tobacco smoking cessation at the community setting
In the healthcare service setting, this paper highlights an approach which focuses on
creating an effective balance between health promotion and treatment and prevention of health
conditions associated with tobacco smoking. The main objective of the paper is to come up with
a health-promoting health service. Thus, the paper will create an environment, the staff-patient
relationship as well as the services to sustain and improve wellbeing and health. Within the
community setting, the main objective is to create and execute a model for the promotion of
health which will allow and empower individuals and communities to have a higher influence
over factors which affect their health (O’ Keeffe, Hayes & Prihodova, 2019). It should be noted
that health promotion represents a well-detailed model for creating a social change to enhance
the wellbeing and health of a community or individual. The main objectives for carrying out this
community health promotion is re-orientate public health services; specific objective will be to
strengthen the development and effectiveness of the program by enhancing capacities in the
targeted community profiling, mobilisation, community participation and offering of services
that are socially inclusive (Grillich et al. 2016).
The second objective will be to create a supportive environment for the care and health
with the specific objective of a planning process which is needs-based as well as integrates
coordination and evaluation between healthcare providers. The third objective of the program is
to reduce the health inequalities in the targeted community increasing the involvement as well as

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the participation of communities and individuals in recognising and addressing the health
inequalities and needs (Heaney, Toker & Ein-Gar, 2015). The fourth objective of the program is
to improve the health of the targeted client group by creating awareness of the health
determinants and effective models used in addressing the health determinants. The program also
aims to increase groups and individual capacity to take action of improving their health, for
instance, through the establishment of personal skills to solve the health issues as well as health
determinants. The last objective of the program is to reduce and prevent disease with the specific
objective of improving cardiovascular disease risk factors like smoking, salt consumption,
alcohol intake, and the vital enhancement in health-linked behaviours.
World health organisation has recognised key principles of community health promotion
which will guide this paper, that is, empowerment which states that health promotions strategies
should allow community and individuals to assume more authority and power over
environmental, socioeconomic and personal factors which affect their overall health. The
participative principle states that health promotion strategies should entail concerned parties in
all stages of evaluation, implementation, and planning. The holistic principle states that health
promotion strategies should enhance spiritual, social, mental, and physical health. The
intersectoral principle states that health promotion strategies should entail the collaboration of
organisations and agencies from relevant sectors. The equitable principle states that health
promotion strategies should be guided and driven by concern for social justice and equity (Ryan
et al. 2019). The multi-strategy principle states that health promotion strategies should apply
different approaches and models in combination with one another, entailing organisation change,
advocacy, communication, education, legislation, community development, and policy

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development. The sustainable principle states that health promotion strategies should result in
changes which communities and individuals can maintain once the initial project has ended.
Tobacco smoking is considered as one of the risk factors for chronic diseases like lung
cancer. Smoking is the single largest preventable cause of illness and premature death as well as
more detrimental to the vulnerable members of the society. Various policies have indicated the
commitment of the government to reduce smoking as well as prevent uptake of tobacco both at
population and individual level, via health promotion practices, empowering the community and
individuals and allowing them to make life healthy. Health promotion is an intricate activity and
difficult to describe in the context of community settings. A significant component of promotion
of health is health education that aims to change behaviour by offering individuals and
community members with the skills and knowledge they need to make healthier decisions as well
as allow them to meet their potential. Nurses have the role in health promotion especially in
prevention at basic and secondary levels. It should be noted that nurses have an insurmountable
knowledge and skills. The use of these skills and knowledge empower individuals to make
lifestyle and healthier choices and changes encouraging individuals to take charge of their care as
well as enhance feelings of individual autonomy.
One of the threats to community health is smoking. Thus, nurses are in a pole position to
aid individuals to stop or quit by encouraging, offering information as well as referring to
services of smoking cessation. There are numerous models to health promotion; each approach
has various aim yet all have the same desired objective, that is, prevent ill health and promote
good health (Sá, Nogueira & Guerra, 2019). There are three promotion levels in health
promotion such as primary, secondary and tertiary. Primary health promotions have the aim of
reducing the risk factors and causes of illness to prevent the disease onset. In the case of this

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program, the aim of the program is to promote smoking abstinence and preventing consumption
via health preventive measures and education. One of the intervention models of this level has
three overlapping circles, that is, health education, for instance being involved in the leaflet’s
distribution creating awareness to the individuals or wider community concerning health risks of
smoking. Another circle is prevention which is aimed at minimising children exposure, for
instance, in 2007 in the United Kingdom, the legal age for sale of tobacco was increased from 16
years to 18 years to reduce the number of young smoking and discourage them from starting to
smoke (Lorencatto et al. 2016). Health protection is another circle to lobby for a ban on tobacco
smoking in major public areas.
In spite of the well-recognised health risks of tobacco smoking, one in five people
continues to smoke (Jackson et al. 2015). Thus, a community nurse must understand and
recognise health linked behaviour to promote health. When delivering health promotion to the
targeted community, the nurse has to be aware of all the aspects and factors that can impact
health, some of which may go beyond the control of a person. Smoking cessation has been
considered as one of the vital steps an individual can take in improving their health as well as
increasing their life expectancy since life averagely smokers live eight years less than non-
smokers (Tchicaya, Lorentz & Demarest, 2016). Secondary interventions in this program will be
used with the intention to reducing episodes of illness as well as prevent the development of ill
health via prompt diagnosis and treatment. In the intervention, individuals will be given pieces of
advice by the community nurse to cease smoking while those who are not willing to stop
smoking, their smoking status should be documented as well as be reviewed every year (Palmer
et al. 2018). Thus, a community nurse maintains accurate data for all individuals. It is prudent

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the nurse has the counselling knowledge and skills that will be required to for specific
individuals to promote cessation of smoking.
Any nursing intervention usually needs planning, assessment, evaluating and execution
which is also applied to community health promotion (Torquati et al. 2018). One assessment
tool/method that can be used in smoking cessation is the ‘5A’ approach, that is, ask, advise,
assess, arrange, and assist. For instance, the community nurse should ask them about the use of
tobacco, that is, the number of cigarettes being smoked daily, assess the motivation and the
willingness to quit smoking (To, Gracie & Ford, 2016). This should entail taking a thorough and
detailed history to evaluate addiction. The community nurse can obtain objective and well-
defined data using a smokerlyser that evaluates the levels of carbon monoxide in expired air
(Burns et al. 2018). It should be noted that the principle of an effective health promoter is to
motivate individuals to allow them to independently make healthier choices through the ability
of the promoter to engage with the people at all levels. People who do not feel motivated are
unlikely to succeed and take part in the promotion program. The nurse should then advise the
people to stop smoking as well as reinforce the benefits of quitting smoking.
Moreover, the nurse should assist them to stop, come up with a quitting timeline as well
as discuss how withdrawal from nicotine can be overcome. Not having the ability to cope or deal
with the physical symptoms of withdrawal may lead to relapse and become a challenge to the
success of quitting. Thus, it is significant that the nurse possesses a good avalanche of
knowledge of the products available to aid in minimising these symptoms. Lastly, a nurse should
arrange for monitoring or follow-up by offering continual engagement and support.

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Good communication skills are vital to the therapeutic association between the patient and the
nurse, and these must be applied effectively by the community nurse by offering up to date,
accurate and clear information. Furthermore, the nurse should be a good and active listener, use
open-ended questions, encourage individuals to talk and show concern to the condition of the
patient (Yan & Groothuis, 2015). Tertiary prevention strategies have the objective of minimising
the progression or halt the complications of the established condition by appropriate
rehabilitation or treatment. A cancer diagnosis has the potential of causing great depression,
distress and an individual can go through many emotional problems (Ali et al. 2016). The
objective of the tertiary intervention is to minimise concerns and sufferings helping individuals
to manage their condition. The role of the community nurse is pivotal in offering support for
individuals as well as families with certain conditions like cancer. The nurse will use the skills
and knowledge as well as the principles of health promotion to educate and counsel the patients
living with the health impacts of smoking.
Factors that influenced health promotion for tobacco smoking cessation
Numerous factors influence health promotion activities, and community nurses must keep
in mind while coming up with the promotion programs. The factors entail gender, age, literacy
levels, religion, culture, and access to current technology. The idea of illness and health is
dynamic and differs according to spiritual, religious, cultural perceptions of a given community.
In this program, healthcare providers acknowledged their culture as it assigned various
responsibilities and roles to men and women. For instance, in the culture of the targeted
community, women are considered as the primary caretaker in the family (Harvey et al. 2019).
Thus, they were invited for health promotion as they could disseminate information to a variety
of people in the community. The program also considered age and gender for all the participants;

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that is, all age groups were invited for the program. However, since the most affected age group
in terms of smoking is the young population, the program organisers invited a relatively younger
population than the rest of the age groups (Sitko et al. 2016).
Barriers and difficulties linked to health promotion
The challenges which are linked to health promotion for community nurses are associated
with the nature of the evidence provided. Even though many scholars in the medical field feel
that specific areas of community nursing have gradually progressed with the execution of health
promotion strategies, others contradict this feeling (Rongen et al. 2014). It should be noted that
maybe the problem lies with the fact that practices that are based in the communities are
normally compared to acute practices in the hospitals. There is empirical evidence which states
that activities of health promotion are specifically poorly represented in the healthcare
institutions settings. As a result, community settings are usually viewed as doing better than the
hospital settings (Lood, Gustafsson & Dahlin, 2015). This may lead to community-based
practices of health promotion being viewed as more focused and progressive than they are. It is
key to note that such comparisons appear to be restricting and misrepresentative since the
evidence suggests that there is little variation between practices of health promotion in the
community and acute settings.
Significantly, the presented evidence seems to state that this area of activity is
underrepresented in all the settings. One important barrier that limits the implementation of
community health promotion is the fact that healthcare providers are normally confused
regarding what entails activities of health promotion (Moreno-Peral et al. 2015). Most nurses do
not fully comprehend the discernible variations between health education and promotion

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activities. Moreover, most nurses are wont to confuse issues of health promotion and health
education, particularly in relation to the operationalisation of their variations. Significantly,
promotion of health should be seen as an umbrella idea, that entails all the activities which are
linked to health and which contribute to the establishment of a state of health in a community or
individual (Winter & Winter, 2018). Health promotion entails potentially overlapping areas of
education, prevention of the disease as well as the protection of the community via
environmental and social engineering. Health education is, thus, viewed as a component of any
strategy of health promotion and focuses on the individual’s lifestyle (Guinta, 2018).
Community-based nurses are normally hindered by inadequate institutional support,
problems of workload, resources and training (Asmelashe, Binega & Asrade 2017). The
community nurses also faced the language barrier in promoting tobacco smoking cessation. Most
of the local communities did not understand the national language which the nurses used to
communicate with them. Another barrier or challenge for the program was the lack of the
capacity especially enough number of community nurses who could drive the objectives of the
program. The program had few numbers of nurses to drive and enhance the objectives of the
program.
Opportunities for community health promotion
A host of countries around the globe have committed themselves to promote health.
Global organisations like the World Health Organization has stated its commitment to providing
support in health promotion activities in member countries (Hodge, 2017). The government of
Ireland and the WHO have come up with various policies, activities and programs which support
community health promotion. A valuable opportunity for promoting health comes from the

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availability of innovative technology and electronic means of therapeutic communication. The
program used an available policy framework on health promotion to guide its activities in the
community. Various policies on tobacco smoking cessation, health promotion and capacity
building were used by the program developers to guide their ethical and moral principles of
health promotion.
Conclusion
Health promotion is a vital component of community healthcare practice. In the past
twenty years, health promotion has been institutionalised and consolidated. Community health
practitioners, researchers, policy-makers acknowledge the role of health promotion in enhancing
public health. In this program, health promotion was used to educate and enlighten people about
the adverse effects of tobacco smoking. The main objective of the program was to initiate a
change in community and individual’s behaviour in tobacco smoking. Various health promotion
measures were used to reach and disseminate the information to the public (Lau, 2017). The
program will improve the health of individuals in the community.

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