Study Of Predicting Model Of Behaviors Of Helping Hospitalized Patients’ Smoking Cessation Among Register Nurses Based On The Theory Of Planned Behavior

Objective The present study aimed to investigate the behavior of helping patients’ smoking cessation among register nurses and its influencing factors based on the Theory of Planned Behavior, and thus providing the theoretical foundation for taking effective intervention to promote such behavior.Methods The study included two parts. The first part was questionnaire developent. Based on the Theory of Planned Behavior, fourteen registered nurses with purposive sampling were chosen in a general tertiary hospital in Anhui province.Data was collected by using semi-structured in-depth interviews and was analyzed with the Colaizzi analysis of phenomenological method.Based on the behavior beliefs, normative beliefs and control beliefs from interviews,the questionnaire consists of five sub-questionnaires:behavioral attitude (BA),subjective norm (SN), perceived behavioral control(PBC),behavioral intention(BI)and behavior(B).After filtering items according to the experts’evaluation opinions,the questionnaire was combined with content validity. Do preliminary experiment on 200 nurses with the initial questionnaire which its validity and reliability were confirmed through getting the opinions of experts and using internal consistency.The second part:a cross-sectional study.The testing questionnaire was distributed among 638 nurses.The collected valid data was analyzed through confirmatory factor analysis (CFA), further screening the items of each sub-questionnaire.The kept items were used to assess the reliability and validity of the questionnaire and exploratory factor analysis (EFA)was used to evaluate the structural validity.A structural equation model(SEM)was built by using AMOS.The goodness offit was tested.Discussing relationship between each latent variable and analyzingthe direct and indirect effects of each latent variable to behavioral intention andbehavior.Results From semi-structured in-depth interviews,five help beliefs were identified in the qualitative research:reducing the economic burden of patients’ families,promoting patients’ rehabilitation, reducing patient’s family members and others with ward of secondhand smoke inhalation, taking up a lot of time, influencingnurses to do other nursing work.Four normative beliefs were identified:hospital leaderships,patients, patients’ families,the head nurse’s and senior nurses’ consistent behaviors of helping the hospitalized patients to quit smoking.Five control beliefs were identified:lack of smoking cessation knowledge and skills, busy work, terms of reference of employment about none of helping the patient to quit smoking,none of strict ban smoking system in hospital,lack of intention of smoking cessation among hospitalized patients.Based on these beliefs,the TPB questionnaire was constructed with 5 sub-questionnaires and 24 items.The Cronbach’s a coefficient was 0.931. All content validity of questionnaire items(I-CVI)were land the Scale-level CVI/universal agreement(S-CVI/UA)was 1.Seven items were cancelled through CFA.Then,the Cronbach’s a coefficient of five sub-questionnai-res(BA\SN\PBC\BI\B)was 0.834,0.864、0.761、0.850、0.872.The Cronbach’s α coefficient of the total questionnaire was 0.894.The Kaiser-Meyer-Olkin measureof sampling adequacy (KMO) was 0.868. Five common factors were got from EFA.The theoretical model was confirmed through EFA. It explained 73.795% of the total variance.The values of the composite reliability (CR)of five sub-ques-tionnaires (BA\SN\PBC\BI\B) were 0.844,0.867,0.767,0.857,0.880,and the values of the average variance extracted(AVE)were 0.649,0.621,0.527,0.601,0.711. The average score of the questionnaire about registered nurse’s behaviors of helpinghospitalized patients’ smoking cessation was 62.32±9.38,and the average score of all items was 3.67±0.55.The average score of BA is the highest among five sub-questionnaires,followed by BI,PBC and SN, and the average score of B is the lowest. The structural equation model showed higher goodness of fit. The model of registered nurse’s behaviors of helping hospitalized patients’ smoking cessation based on the TPB explained 43 percent of the variance of variation of nurses’helping patients stop smoking behavior and 36 percent of that of the behavior intention. The direct effect of BI and the indirect effect of PBC are most significant factors influencing the nurses’ behavior.Conclusions Registered nurses approve of helping hospitalized patients smoking cessation,all of them believe that helping behaviors is very important. But the nurses’helping ability and helping behaviors is very insufficient.Managers should take a variety of methods to promote nurses to help hospitalized patients smoking cessation.It is the key to improve PBC and BI about helping the hospitalized patients smoking cessation for the registered nurses in the process of intervention.