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While laws, regulations, and public information concerning tobacco smoking may have reduced the number of smokers in many countries, cigarette smoking is still one of the major threats for national health in Canada. Health promotion through workplace interventions has proven to be beneficial for helping smokers to quit the harmful habit. The present paper provides an evaluation of the Vancouver Coastal Health (VCH) smoking cessation program from the viewpoint of the social cognitive theory and the theory of planned behavior.
VCH provides thorough information on its health promotion program for citizens of British Columbia. First, VCH addresses the issue of smoking by showing the advantages of discarding the harmful habit (“Tobacco cessation,” n.d.). Second, the website gives a hyperlink to access information about the BC smoking cessation program and informs the reader about the QuitNow helpline (“Tobacco cessation,” n.d.). Third, VCH offers a free 26-week smoking cessation program that provides nicotine replacement therapy and group counseling.
Moreover, the website gives contacts of the youth clinics to address the question of smoking among teenagers (“Tobacco cessation,” n.d.). VCH also describes the non-smoking environment of the health institution that is encouraged during the hospital stay. In brief, the VCH health promotion seems to be very helpful for smoking cessation.
Theoretical Basis
Before commencing the evaluation of the workplace health promotions, it is beneficial to state the theoretical basis of this paper. The first theory that may appear useful for workplace interventions concerning smoking is the social cognitive theory (SCT). SCT states that three main factors influence the likelihood of behavioral change: self-efficacy, goals, and outcome expectations (National Cancer Institute [NCI], 2005). The core of the theory is that personal factors, environment, and behavior affect one another (Martin et al., 2014).
SCT integrates five concepts: psychological determinants of behavior, observational learning, environmental determinants of behavior, self-regulation and moral disengagement (Harbin, 2016). Four determinants are fundamental to translating information into successful health practices. They are knowledge, perceived self-efficacy, outcome expectations, and perceived facilitators/impediments (Harbin, 2016).
If a person does not know what benefits a behavioral change may bring to his or her life, they will be unlikely to adopt it. Moreover, to discard the damaging habit, a person must have self-efficacy so that he or she is more self-motivated to continue developing the behavioral change through difficult times. Besides, people should be aware of internal and external results and outcomes of the habit and know the possible facilitators and impediments they might encounter. In conclusion, SCT states that the organization should reflect upon its collective values, beliefs, and purposes, as the company’s culture influences the personal behavior of its employees.
The second theory this paper is focusing on is the theory of planned behavior (TPB). In the last three decades, TPB has become one of the leading cognitive models to predict specific behaviors as it can explain many variances with fewer factors (Hukkelberg, Hagtvet, & Kovac, 2013). According to the theory, people acquire behavioral intention and then realize their attitude to it to see if they want to adopt the behavioral change. After that, the individuals apply their subjective norms to see if the key persons that matter agree or disapprove of the modifications in behavior.
TBP also states that the realization that their actions are under complete control can make people try harder to change their habits. As Hukkelberg et al.’s (2013) study show, TPB proved to be relevant for quitting smoking, as personal intentions, social norms, and regulations significantly influence smokers’ behavior. In short, TBP is transparent and straightforward for addressing smoking cessation in health promotion programs.
Critical Analysis
The Vancouver Coastal Smoking Cessation Program is briefly described in the introduction of the present paper and, from the first glance, is very helpful for smokers considering smoking cessation. While the program seems to be well-organized and theoretically justified, it has some evident flaws. According to the offered scheme, VCH adopted the theory of planned behavior as the primary approach to health promotion. The choice seems to be controversial, as the modern trend is shifting towards the social cognitive theory and the transtheoretical approach (Harbin, 2016).
VCH addresses the personal attitude of the reader by stating that “quitting smoking is the best thing you can do” (“Tobacco cessation,” para 12). This proclamation can also be related to expectations of the social cognitive theory; therefore, theoretically, providing the reader with this statement is justified and effective (Goetzel et al., 2014). However, the sole sentence at the end of the webpage does not seem to be enough to influence the personal attitude of the reader and provide a stimulus to quit smoking. In brief, the smokers not considering smoking cessation are left out; therefore, VCH might want to imply smoke-free lifestyle propaganda through their website.
Second, VCH provides links to British Columbia smoking cessation program and declares the program to be free for everyone. The fact that the future affiliates do not have to pay for the behavioral change they are going to accept adds to their self-efficacy, which is crucial for SCT. It also gives the participants a strong belief that they will be able to control the habit, as they do not need to doubt their ability to afford the program.
This fact is central according to TPB; therefore, drawing the reader’s attention to the non-existent cost of the program helps. Moreover, as Goetzel et al. (2014) point out, workplace health promotions are effective only if they are cost-efficient for the employer so that they can be sustained for an extended period. The government intervention into the money question of health promotions has become vital since 2008, as the global financial crisis forced all the enterprises to re-evaluate their commitment to social programs (Rootman, Pederson, Frohlich, & Dupéré, 2017). Thus, the fact that the BC government covers a part of the program makes the matter more effective.
Third, VCH gives phone numbers of health institutions that can provide help in smoking cessation. Among the offered services, Youth Clinics contacts are offered, which draws us to the question of the program orientation. The VCH smoking cessation program is meant for all age groups, including the youth, but mostly for individuals with low and medium income level. People with a higher income are more likely to address their family doctor or other trusted health provider (Canadian Institute for Health Information, 2016).
The policy seems to be rather weakly adapted for young people, as it provides little information on confidentiality of the program. It is common knowledge that the young generation often smoke without their parents knowing about it. Therefore, VCH needs to state that the implication to healthcare provider concerning smoking cessation is strictly confidential to make the intervention more relevant for the youth. At the present state, young people are not likely to apply for the program.
At the bottom of the page, VCH website states that the institution is both smoke- and vape-free. The policy positively influences the subjective norm of the smoker, which is important for TPB. NCI (2005) also states that the presence of things that make it easier to adopt a behavioral change affects perceived behavioral control. Thus, the fact that the hospitals do not allow smoking on their grounds is beneficial for the patients from the TPB viewpoint.
There are also some additional changes VCH may consider to incorporate into the program. First, individual strengths and possibilities can be drawn through creating psychotherapy groups where ex-smokers share their experience of smoking cessation. According to SCT, such activities add to the effectiveness of the approach by promoting behavioral capability, as ex-smokers show that the harmful habit can be controlled (Harbin, 2016). Second, the program may address smokers who have not yet considered smoking cessation by applying the transtheoretical model (Sarbandi, Niknami, Hidarnia, Hajizadeh, & Montazeri, 2013).
According to the theory, the VCH health promotion program does not influence smokers in their precontemplation stage. To address this audience, the program might consider providing personalized information about risks of the habit (NCI, 2005). Third, the program is available only in one language, which makes it inaccessible for non-English speakers; thus leaving out a considerable part of the Canadian population. To summarise, while offering appropriate help in smoking cessation, VCH health promotion program seems to lack several pivotal points.
Conclusion
Applying theoretical knowledge toward health promotion programs is not only rational but also crucial for its consistency and effectiveness (Harbin, 2016). The VCH smoking cessation program seems to be based upon the theory of planned behavior, as all the main concepts of it are covered. On the one hand, the interference is exceptionally beneficial for smokers with low and medium income. On the other hand, the program does not touch upon such questions as confidentiality and propaganda. Ultimately, VCH offers tremendous possibilities to assist smokers in quitting the harmful habit; however, some adjustments can be made to improve the quality of the health promotion.
References
Canadian Institute for Health Information. (2016). Trends in income-related health inequalities in Canada: Technical report. Web.
Goetzel, R., Henke, R., Tabrizi, M., Pelletier, K., Loeppke, R., Ballard, D., … & Metz, R. (2014). Do workplace health promotion (wellness) programs work? Journal of Occupational and Environmental Medicine, 56(9), 927-934.
Harbin, T. (2016). Evaluating workplace health promotion. Journal of Management Policies and Practices, 4(2), 1-10.
Hukkelberg, S., Hagtvet, K., & Kovac, V. (2013). Latent interaction effects in the theory of planned behaviour applied to quitting smoking. British Journal of Health Psychology, 19(1), 83-100.
Martin, C., Rivera, D., Riley, W., Hekler, E., Buman, M., … & King, A. (2014). A dynamical systems model of social cognitive theory, presented at 2014 American Control Conference, Portland, OR, 2014. 2407-2412.
National Cancer Institute. (2005). Theory at a glance: A guide for health promotion practice (2nd ed.). Web.
Rootman, I., Pederson, A., Frohlich, K. L. & Dupéré, S., (Eds.). (2017) Health promotion in Canada: Critical Perspectives on Theory, Practice, Policy, and Research (4th ed.). Toronto: Canadian Scholars’ Press Inc.
Sarbandi, F., Niknami, S., Hidarnia, A., Hajizadeh, E., & Montazeri, A. (2013). The transtheoretical model (TTM) questionnaire for smoking cessation: Psychometric properties of the Iranian version. BMC Public Health, 13(1), 1-6.
Tobacco cessation. (n.d.). Web.
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