Professional training to reduce children's exposure to second-hand smoke in the home: evidence-based considerations on targeting and content.

Aims: Proponents of theory-based evaluations argue that the type of evidence needed by public health decision-makers is not simply whether interventions work or not. A more fruitful approach is to understand the contexts and circumstances associated with effectiveness. This article aims: to firstly understand factors influencing professionals' practice following their participation in training that aimed to reduce children's exposure to second-hand smoke (SHS) in the home via increased usage of brief interventions; and secondly to consider the implications of these factors for improving the skills of a diverse workforce.

Methods: Questionnaires were issued to the 231 participants pre- and post-training and at three-month follow-up. Four focus groups and four interviews were run with 16 people who had attended the training in the previous four to eight months and who performed a wide range of professional roles, reflecting the diversity of those trained.

Results: The three-month follow-up data indicated that some, but not all, participants had engaged in components of the brief intervention and changed their practice. This difference was largely explained by professional role. Those working in a health-visiting role or team were considered better placed to support families through a process of restricting SHS exposure in the home. Triangulated data also indicated that these professionals more often practised elements of the brief intervention. There was also some evidence that the training did not equip participants with the full range of information they wanted, or with the skills that they felt that they needed.

Conclusions: Decisions on who to target for training need to be informed by an understanding of the contexts in which professionals work and the opportunities and constraints within these. Those working in a health-visiting team are credible message carriers, have opportunities to develop a relationship with families, and can be well placed to provide families with sustained support. To do so, they need clear messages on precisely how to reduce exposure. In addition, they need the skills to support families through a process of change.