Identifying clusters in practice nurses' adherence to smoking cessation counselling guidelines


  • C. Hoving
  • M. Stroom
  • D. de Ruijter
  • H. de Vries
  • E. Smit


Background: General practice nurses often provide smoking cessation counselling, but adherence to evidence-based counselling guidelines is suboptimal. To better understand the heterogeneity in guideline adherence, this study’s aim was to identify subgroups based on guideline adherence beliefs and to test how these subgroups differ on adherence behaviour. Methods: Cross-sectional online questionnaire data from 157 practice nurses was used to conduct a hierarchical cluster analysis. Clusters were based on perceived pros and cons, and self-efficacy to perform guideline steps. Clusters found were compared on general adherence and performance frequency of counselling steps (always-never) using t-tests and Mann-Whitney U tests, respectively. Findings: Two clusters were identified; Assured Optimists (AO; high pros, low cons, high self-efficacy) and Pessimists (P; low pros, high cons, low self-efficacy). Assured Optimists reported significantly more often to be adherent in general (MAO=6.05, MP=4.47, T=3.37, p <.01) and to perform counselling steps related to active counselling (e.g. increasing motivation to quit, MdnAO=2, MdnP= 3, U= 1845, p<.001). No differences were found for protocol elements focused on assessment. Discussion: Practice nurses who reported a more positive view on their adherence to smoking cessation counselling guidelines are not more likely to assess smoking behaviour and beliefs compared to those who reported a more negative view, but are more likely to actively counsel their smokers. Validation of the cluster solution found is recommended. Interventions focusing on improving practice nurses’ beliefs on smoking cessation counselling guideline adherence might be more likely to find results on active counselling steps than assessment steps.





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