We identified 13 facilitators and barriers to change commitment or change efficacy as shown in Table 3. These factors are thus important for developing organizational readiness to implement SFSH in Danish vocational schools.
A primary facilitating factor for change commitment is believing that the school has a role and duty to promote health and contribute to smoking prevention. More specifically, whether or not their smoking prevention responsibility entails establishing SFSH to avoid having new (young) students initiate or increase smoking when they enroll at the respective school:
“It [health promotion] has become a school responsibility (…) to be ahead as a smoke-free school” (Manager School F).
“The reason why we chose to have smoke-free school hours was not to put pressure on those who smoke; it was to not make new smokers. Because we found out that many new students who started at our school began to smoke while at the school” (Teacher School A).
At all the schools, change commitment negotiations further reflect trends in the surrounding society and the different main subject areas, as these represent different types of workplaces and cultures. At schools B and C (representing Care, health and pedagogy), SFSH is seen as a meaningful initiative, as many of the workplaces they are educating the students to join already have or are in the process of establishing smoke-free work hours (e.g., hospitals, municipalities and child care services):
“I have to say, what really made an impact was that our municipality established a smoking ban during work hours for all employees” (Manager School C).
This is also acknowledged as a motivating factor at schools D and F, which represent the construction sector (Technology, construction and transportation) and the business sector (Administration, commerce and business), respectively:
“You can’t smoke if you are employed to work on [state construction sites, like] the metro… (…) so I suppose it is a good thing (…) if you don’t smoke” (Manager School D).
However, it was articulated at school E (Food, agriculture and hospitality) that the hospitality sector (e.g., restaurants) is not becoming smoke-free:
“I think as a vocational school (…) you need the profession (…) to support it, like they have smoke-free-work-hours (…) at the hospitals (…), but in restaurants it is okay that you go to smoke out in the back” (Manager School E).
Thus, the motivation to establish SFSH is influenced by the smoking practices and cultures at apprenticeships and future workplaces.
Additionally, a perceived benefit of and strategy for establishing SFSH is that school class pedagogy will no longer be influenced by students’ constant need for cigarettes or ‘smoking breaks’, which means fewer disruptions during teaching:
“It is an advantage on the teacher side to be able to keep the students in class and not have them asking for smoking breaks all the time” (Teacher School C).
A primary barrier to change commitment is believing that SFSH violate personal freedom. The argument asserts that the school has a responsibility to enlighten or inform their students about health but should not take away individual choices by introducing SFSH:
“I think we have a great responsibility [for smoking prevention] on the informational level. (…) But I have to say, personally, I have never actually been a fan of a total smoking ban. I just haven’t. I think it is an interference with personal freedom.” (Manager School C).
At school B, many organizational members believed that SFSH violated personal freedom, which led to great resistance among employees, and the school management withdrew the policy after a six-month period. The school manager described the situation as a fight about values:
“I dare to claim that our employee group was divided in two camps independent of smoking status: ‘Do you believe it’s okay that we as school make these kind of rules?’ or ‘are you opposed to making these kind of rules?’” (Manager School B).
Another barrier to change commitment is believing that smoking is not a sufficiently important issue to address because many vocational students have other challenges, such as mental health problems or weed addiction:
“the smallest concern for them is if they smoke a cigarette” (Teacher School A).
Having clear rules and responsibilities regarding sanctioning and enforcement is seen as a prerequisite for implementing SFSH:
“So, we had to clear it with our staff on ‘how do we do this?’: Rules, framings and clarity (…); when you’re caught smoking during school hours, you’re sent home” (Manager school A).
At both schools that have implemented SFSH, the responsibilities for enforcement and sanctioning are formulated as part of the schools’ rules of conduct. This means that the organizational members are obligated, as part of their professional tasks, to either send students home from school or give them an oral or written warning if the students are caught smoking during school hours. In contrast, no clear responsibilities or sanctioning procedures were in place at school B, as the school management believed it conflicted with the school’s organizational values:
“If we were to go and enforce these rules [SFSH] and there is a negative consequence to it, our organization would really struggle with that. But it was what they [the students] needed” (Manager B).
Consequently, formulating clear rules for sanctioning and enforcement facilitates change efficacy, and this needs to be negotiated so that organizational members understand their responsibilities.
Another important facilitator for change efficacy is that schools must develop a joint understanding about SFSH. The argument is that implementation is a ‘team sport’, and if there is no joint understanding, implementation is impossible:
“It is apparent – I can’t implement anything at this school if I don’t have my employees with me” (Manager School D).
“I think it was that we didn’t have a joint understanding about it; like it wasn’t something where we all held each other’s hands saying, ‘this is a good idea’ (…); there was a REALLY big controversy about it” (Teacher School B).
Additionally, developing skills and confidence to deal with student responses to SFSH facilitates change efficacy:
“You have to equip the teachers to acknowledge that it is damn hard and sometimes conflictive [SFSH] (…) and make sure that they feel confident and have the right skills and know how to react” (Manager School A).
Respondents articulated that smoking has a social function at vocational schools, and replacing ‘smoking communities’ with other activities is negotiated as a facilitating strategy to improve the implementation of SFSH:
“I think it [smoking] has a social function and attraction (...); therefore, I like the idea of (…) creating other social magnets. It could be (…) establishing physical structures, which calls on being social together without smoking” (Manager School F)
Offering smoking cessation help is seen as a necessary supporting action if/when implementing SFSH, as many vocational students are addicted to cigarettes:
“We presented it as of our introduction, where we say, ‘this is a smoke-free school, but it is possible to attend smoking cessation courses’” (Manager School C).
“I think it should be a law [if implementing SFSH] that you’d have to offer smoking cessation courses” (Teacher School E).
Legislation on SFSH is perceived as facilitating change efficacy in two ways. First, it will eliminate a potential negative competitive factor for schools’ ability to attract new students, and second, a law mandating SFSH will help with communication in enforcement situations, allowing managers and staff to place responsibility on the state rather than the school:
“If there really are students calculating, ‘okay, in that school we can smoke, and in that school we can’t’” (Manager School C).
“I need to be able to say, ‘it is forbidden [by law] to smoke here’” (Manager School E).
A primary barrier to change efficacy is how to administer sanctioning and enforcement. Even though SFSH is practiced at schools A and C, it is well-known that some students still smoke during school hours; therefore, managing enforcement is a daily challenge:
“Sometimes they come in (…) and we can smell what they have been up to. IP2: But we must catch them in the act. IP1: (…) so how do we administer the level of our interference? (…) It is something we discuss among the staff” (Teachers School C)
Likewise, defining well-functioning enforcement and sanctioning procedures at schools without experience implementing SFSH is recognized as a barrier.
Another barrier to change efficacy is that some believe or have experienced that enforcement negatively influences student-teacher relations. In various cases, a police officer narrative was expressed, and it was argued that enforcement might damage important student-teacher relations:
“In this school, we don’t go around keeping eye on the students (…) I would rather talk with the students about if its good weather or if they had a good class (…) The staff (…) have the same dilemma (…) we want to keep good relations with our students” (Manager D).