Tobacco use is one of the leading causes of preventable diseases and death worldwide, accounting for over seven million deaths each year . These deaths include an estimated 890,000 non-smokers who were indirectly exposed to second hand smoke . Around 10% of all deaths from a non-communicable disease (including cardiovascular diseases, respiratory diseases, cancer and diabetes) are related to tobacco use, and most of these occur in low- and middle-income countries (LMIC) . By 2040, the prevalence of tobacco use globally is expected to decrease to less than 5%, but because of the steady population growth, combined with the tobacco industry’s focus on LMICs, the number of smokers is likely to increase in these countries . The factors associated with smoking in LMICs include poor education, low-income level, unemployment and being male . Similarly, despite the overall decline in smoking prevalence in high-income countries (HICs) over the last few decades, the rate of smoking remains disproportionately high in disadvantaged priority populations .
The latest estimate suggests smoking kills two in three persistent users in Australia . In previous decades, the number of fatalities caused by tobacco use has been vast. In the 50 years from 1960–2010, it was estimated that smoking killed around 821,000 Australians . Even today, smoking is still directly responsible for the deaths of nearly 19,000 Australians annually . In 2011, tobacco smoking was estimated to be responsible for 80% of the lung cancer burden and 75% of the chronic obstructive pulmonary disease (COPD) burden in Australia . Reducing the burden of disease is a priority of public health, as is the prevention of the uptake of smoking and the cessation of smoking by current users. It is the responsibility of those in health policy and service to gather a reliable evidence base so they can ensure they are both accurate and effective in their response and strategies to reduce smoking rates, and thus the burden of disease .
Public health policymakers and service providers in smoking cessation programs are increasingly expected to base their decisions on the best available research evidence in order to assist informed and progressive decision-making . Systematically incorporating evidence-based research into policy formulation and health policy-making supports the delivery of high quality, effective and efficient health services . Furthermore, it ensures that reasonable human and financial investments are made into public health and healthcare . However, in practice, intervention decisions are often based on the short term benefits, lacking systematic planning and reviewing of the best avialable research evidence regarding effective approaches hence resulting in slow uptake of research evidence into practice .
This failure of optimally using research evidence in health policy and practice has resulted in a gap between the large body of research evidence produced and its uptake into health policy and practice . As result of this knowledge-to-action gap, most countries population cannot gain optimal healthcare and promotion benefits, which leads to decreased productivity and poorer quality of life. Also, there is a possibility for 20–30% of individuals in the various healthcare systems receive potentially harmful or not needed care, as well as, have limited uptake of effective treatments .
Previous research has documented the poor or inadequate use of research evidence by policy- and decision-makers due to several factors related to individuals, organisations and the research itself . Several factors relating to individual action presents a significant barrier to the use of research evidence by policy and key decision-makers. Importantly, the individual decision-makers’ perceptions, values and beliefs regarding the research evidence are considered major challenges to its use in the policy-making process [15, 16]. Furthermore, the lack of access to health policy research and inadequate skills in knowledge translation and management limit the policymaker’s ability to access and synthesise information on which to base decisions [15, 16].
The digital support approach, or the electronic health (eHealth) approach is considered a new opportunity for prevention of health-risk behaviours, and for tackling the global burden of smoking by expanding the accessibility of cessation programs to all smokers . eHealth interventions have unique advantages, including affordability, efficient delivery, easy accessibility and a wide reach of large segments of the population. Therefore, recent studies suggest that digitally support approaches, such as eHealth and mobile (mHealth) interventions, could hold significant promise to improve smoking cessation. Previous systematic reviews have investigated the effects of eHealth and mHealth interventions upon smoking cessation outcomes [18–21], however they are limited in scope. A blanket acceptance and implementation of mHealth cessation programs is not only unhelpful, but potentially harmful in the face of a lack of thorough review of their effectiveness. A discerning and reliable evidence base from which policymakers can operate is imperative to achieve this important goal in population health.
Within broad scope of eHealth smoking cessations interventions, some strategies can help people quit; however, several barriers may affect their implementation by policymakers and service providers. The first barrier is the sheer quantity and differences in quality of the published primary studies on eHealth interventions for smoking cessation. The clutter makes it difficult to identify effective and reliable interventions for adoption. It is clear that policymakers and service providers have little time to conduct complex literature searches, screen through results, and then interpret the plethora of results of primary studies [15, 16].
Policy makers and service providers have a responsibility to implement eHealth programs demonstrated through research as effective. Systematic reviews provide summary evidence from many research studies that have been risk assessed, and are useful for evidence informed decision-making. Generally, previous systematic reviews in smoking cessation have focused on the effects of particular devices on the outcome of smoking cessation or on a specific age group or population [18–21]. However, until recently, no comprehensive systematic review has compares the effects of various eHealth platforms and the effects of modifiers among the published eHealth platform interventions.
Little research exists as to what policymakers and providers know and believe about eHealth strategies for smoking cessation, and how these compare to the evidence from well conducted studies. We hypothesised that policymakers and service providers hold perceptions about the effectiveness of interventions that may be contrary to the evidence-base derived from advocacy, promotion, and word-of-mouth. We sought to identify the gap between policymakers’ knowledge and existing evidence to determine the risks that may be present as a result of flawed perceptions that influence policy and practice. In doing this, there is simultaneously an opportunity to actively engage policymakers and service providers with the current best evidence. The current best evidence for smoking cessation is a recent systematic review conducted by Do et al., which evaluated and compared the effectiveness of several eHealth interventions for smoking cessation, including mobile phone based, computer based and web based programs. A summary of the findings on the effects of eHealth smoking cessation interventions based on Grading of Recommendations Assessment Development and Evaluation (GRADE) guidelines are described in the publication . The key findings and considerations for public health practice in plain language are described in a user friendly the Health Evidence™ summary . The review is “strong evidence” as independently assessed by healthevidence.org (rated 10 out of 10). The findings are of significance and trustworthy for public health practice. Given the strength of the review, the findings are worthy of consideration by policy and decision makers. By providing systematic review evidence of the effectiveness of eHealth programs, policymakers and service providers can potentially avoid advocating for interventions that have little or no effect. The referral by policymakers to programs that are not evidence-based could result in wasting the already limited resources and introducing extra burdens on excessively demanding health services. The current study explores the perceptions of Australian policymakers and service providers involved in smoking cessation programs. This study seeks to identify whether or not their prior perceptions about eHealth interventions are in contradiction with the best available evidence of effectiveness.