Workplace Tobacco Management Project Research Findings (Evaluation) Report by Alcohol Tobacco and Other Drug Association ACT
1. Executive Summary
This report presents the research findings (evaluation) of the Workplace Tobacco Management Project (WTMP). The WPTMP aimed to:
- Support the development and implementation of Workplace Tobacco Management Policies (focused on staff) in nine sites (three from the alcohol and drug sector, three from the mental health sector and three youth organisations)
- Increase awareness of workplace tobacco management policies amongst staff
- Reduce harms associated with smoking behaviours for the staff in the pilot sites
GovernanceThe governance elements were:
- Memorandums of understanding (MOUs) between the three peak organisations involved (ATODA, Mental Health Community Coalition ACT and the Youth Coalition of the ACT), to ensure sector leadership was at the forefront in delivering the project.
- MOUs between ATODA and each of the participating sites to describe the two-way responsibilities of the project.
- The WPTMP Advisory Committee aimed to shared experiences between sites and act as a way to distribute information.
Project managementProject management elements were:
- Employment of a project officer to assist sites with the development and implementation of their Tobacco Management Policy through the development and updating of the site workplan.
- Development of project template documents (policy, work-plans and site resources)
- Site meetings which occurred regularly between the project officer and staff and management at each site.
- An email distribution list which was developed and heavily utilised during the project to inform project updates and to communicate data collection periods.
Monitoring and evaluation
- Baseline and three follow up surveys were conducted among staff and at the organisational level.
- Changes in key variables were monitored over the life of the project, with this information feeding into the WPTMP steering group.
- A number of abstracts and presentations were prepared and delivered discussing project outcomes and processes.
The surveys measured:
- Tobacco policy elements currently in place
- Prevalence of smoking amongst staff
- Levels of nicotine dependence amongst smokers
- Intention of staff to quit or reduce
- Previous quit attempts (smokers and ex-smokers) including stories about the Quit experience (QUAL)
- Staff knowledge of workplace tobacco policy
- Staff observations concerning smoking culture (or no culture of smoking) at work
- Circumstances impacting on decisions to quit smoking for smokers and ex-smokers
- Barriers and enablers to policy development and implementation in the workplace (QUAL)
- Attitudes to tobacco in specified workplace settings
- Organisation approach to policy development
- Staff involvement in policy development processes
Policy development and implementationDespite numerous barriers to development and implementation of tobacco management policies in workplaces:
All sites implemented tobacco management policiesThis achievement was as a result of the information provided by baseline and followup surveys which monitored the policy development and implementation process. The employment of the projects-project officer usually worked with site champions and leaders who were able to work together on the work-plan actions. The work-plan was valuable in ensuring areas identified for action were acted on.
Most sites were able to involve stakeholders in the policy development processMost sites had included staff tobacco management as a standing agenda item in their regular staff meetings and it appears debate occurred around elements of the policy such as designated smoking areas and whether smoke breaks were paid or unpaid. Using a less threatening framing of the policy (Workplace tobacco management vs Smoke-free) also contributed to involvement.
Levels of support for the policy implementation across all sites was goodWhile initial support for the policy was low, by the final survey over half of all staff were highly supportive of the policy implementation, 80 percent of boards were supportive and 100 percent of all managers were supportive. While clients were not directly involved in completing surveys, staff were asked to indicate how supportive they thought clients would be. From baseline, staff thought that no clients would be supportive. In the final survey staff indicated that almost 40 percent of clients were now supportive of the policy.
Framing policy development and implementation in a positive and empowering way achieves results, a focus on harm reduction makes tobacco policy congruent with sector philosophies
When staff were asked to describe the way policy development and implementation was occurring at their site, overwhelmingly the most described approach was ʻempowermentʼ and ʻpositiveʼ. At the commencement of the project efforts were made to inform staff that the approach used was not about banning or making staff quit smoking, it was about helping all staff reduce exposure to tobacco smoke (health framing) and to support staff who wanted to reduce and or quit. When tobacco policy was framed as consistent with the service delivery philosophy of the ATOD, mental health and youth sectors, people were more accepting.
Attitudes and behavioursChanges to tobacco assessment and treatment, particularly for clients was observed late in the project
Across two particular variables staff reported changes in their thinking. They related to client tobacco use. A notable reduction in the number of staff thinking clients did not want to reduce or quit smoking was observed from 70 percent to 45 percent, although this is still higher than other studies have reported. In the baseline survey about 30 percent of staff believed that if clients were not able to smoke this would lead to impaired treatment outcomes. This reduced to fewer than 18 percent in the final survey. In the final months of the project a staff training program was conducted which may be the factor contributing to the increased awareness of clients wanting to quit by staff.
Smoking ratesNo statistically significant reductions in smoking rates were observedIf the rates of current smoking were declining related to the project initiatives alone we should see no change in the category of never smoked. This tells us that current smokers were leaving the workforce or not participating in surveys and the number of people who have never smoked is increasing in the pilot sites. The question then arises: Is it because sites are undertaking this work which is forcing current smokers from the workplace?
The project facilitated a doubling in the number of quit attempts among smokers
Of the smokers participating in the pilot project, half reported a doubling of the quit attempts during the project period. This is most likely due to the NRT provided as part of the project.
Nearly all smokers want to quit
Similar to other studies, smokers participating in the Project overwhelmingly want to quit (over 90% at each survey period) and most are organising how they are going to quit (60-70 percent).
When compared to baseline, most smokers in the pilot sites are now categorized as having a low to moderate nicotine dependence.
There has been a small increase in staff confidence to quit and a small decrease in staff self assessed levels of nicotine addiction
At the commencement of the project 55 percent of staff were considered to have a moderate to high nicotine dependence. At the conclusion of the project the proportion of staff with a moderate to high nicotine dependence has declined to 38 percent.
Debriefing, meal breaks and building workplace relationships are facilitators of smoking in the project sites.
Almost all staff reported that smoking was used to debrief after a stressful work situation, meeting or client interaction. Smoking was also reported as a standard part of breaks and meals. Relationships between staff and clients were also reported as being enhanced through smoking.
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Strengths and weakness of the chosen evaluation designThere are a number of factors that have contributed to the success of this evaluation and a number that have had a negative impact. Both are discussed below.
Staff turnoverEvaluation limitations: One of the limitations of the evaluation was the ability to draw too many inferences from the repeated measured design. This was in part due to the high turnover of staff across a number of participating sites. Upon inspection of the
four data periods it was identified that only 13 participants had completed the baseline and all follow-up surveys. Fifteen had complete baseline and follow-up 2. Follow-up 2 and final survey saw a much higher number of staff completing surveys (41).
Staff participation in electronic surveysOne of the successes was the participation rate of staff in the completion of the electronic surveys. Across the four time points, staff participation was 77, 52, 54 and 62 percent. It is usual for internet based surveys to have participation rates of 20-30 percent.
Survey results informing workplansPart of the original design was to ensure that organisational and staff surveys were used to inform decision-making and this was largely successful. When an organisation completed their baseline survey, the results informed the content of the sites work plan. One area where staff survey results could have been better utilised was to feed back some of the staff attitudes and beliefs data to sites for myth busting exercises or additional training as there were minimal shifts related to staff attitudes concerning their own smoking related behaviours in the workplace.
Conclusions and implicationsOverall, the results of this evaluation point to a successful project. There are areas where results could be enhanced with additional focus in the future. The task of developing and implementing tobacco policies in sites was very successful using the methods identified by sites and by using the work plan structure. Staff were heavily involved or were very aware and supportive of the process (project aims 1 and 2).
A relative success was reducing the harms associated with tobacco smoke exposure. While there was a decrease in smoking rates amongst staff and reductions in consumption of tobacco, these were not significant changes. Passive smoke exposure should also be significantly reduced due to designated smoking areas and a change in cultures associated with smoking.
The least impact observed was in attitudes and some behaviours related to smoking by staff. Many staff are fearful of clients not being able to smoke and feel that smoking is a useful tool to manage other symptoms. There is also a disconnect about staff thinking clients are not willing or ready to change smoking behaviours or quit. This could be addressed with additional staff training or research being conducted within the three sectors to examine the issue.
Policy development and implementation were facilitated by a feedback loop from each survey period into site work plans. This process occurred primarily through the WTMP Project Manager. This process proved vital in the progression of the project. This became evident when, for a short time the project officer position was vacant and some momentum was lost.
Staff engagement is vital in changing support for these policies in the workplace as demonstrated by this evaluation. The key to this approach was identifying an individual or a group of individuals within each organisation that became the champion/s for the project.
With an ability to re-identify data a more concerted effort to follow up participants could have been achieved. For those who had left services, a natural experiment process could also be created if staff consented to follow up interviews. Comparisons of smoking reduction could then be made between samples of WPTMP participants and non-participants. Broadening the project to a larger group in the future will allow greater participation and ability to conduct inferential analysis.
Subsidised NRT was offered as part of the project at a later stage and follow up of this group of staff. A focus on following up these staff has begun, but is yet to be completed. Any expansion of this project in the future will need to consider the follow up and analysis of data from this group of staff.
Note: further conclusions, implications and recommendations will be drawn out from the secondary evaluation process which will be undertaken outside of the Health Promotions Unit funded component of the Workplace Tobacco Management Project. These will be available in early 2012.