Table 2 Respondents’ examples of good practice and areas for improvement identified by the research team from open questions

 Screening for smoking and proactive use of information

We always ask whether they smoke when they sign into the service. We also ask if they would like support to give up and if they say yes this will form part of their support plan. (P20)

When they come for interview before they move in… we ask about how much they smoke and whether they would like to quit. We can refer at this point, but usually we wait until they move in. (P31)

We ask all service users if they would like to change their smoking habits, but we are guided by the client. If they decline, we do review in future sessions… (P19)

Smoking is covered in the physical health checklist in the needs assessment. It may also come up in the finance/budgeting section because the cost can be a barrier. (P42)

 Relationships with stop smoking services

The relationship we have with the GP and the stop smoking clinic through them. As most residents are on medications, their smoking is brought up each time they have a medication review. In addition, each time the residents have a tuberculosis test (twice a year), smoking information sessions are held then also. It is spoken about often to residents so it is not something that slips under the radar. (P12)

The most benefit we have found is around partnering with (name’s organisation). We also ran a Better Health at work campaign and we reduced staff smoking rates by 50% which I think benefits our clients because we are setting good examples. (P22)

We found the cessation service visiting once a week to be helpful. It took a while to build it up, but most of what is taken up [is influenced by] their peers/other residents… They often don’t want to engage unless they hear someone else has a good experience. (P15)

Having a healthy living week is good, and getting in the local cessation service works well. Especially when they bring the visual tools, it’s less about a lecture, it’s more interactive. It gives smoking and personal harm more context, that is measurable, rather than just being told that smoking is bad for you.(P43)

 Vaping encouraged as an alternative to smoking

We had great success when we bought people vape kits… We saw a large number of people switch to vaping because we saw people supporting each other and helping each other, and that was more effective than sending someone to a group. (P5)

We find harm reduction to be effective. Some service users have switched to the vape, and they eventually smoked less than they did previously. (P42)

We did have some success with the local vape store. I think it was because we were able to provide something tangible for service users to try, rather than just running an information session. We provided the information, and then had vapes available for them to try which was quite good. (P40)

The main service that were finding clients are interested in at the moment is going onto a vape through the NHS. As they get the vape and liquid for free, we have had more residents wanting to engage with the service and try to stop smoking than before. (P28)

 Lack of staff training on smoking and smoking cessation

We don’t have any formal training, but we do have leaflets around from our local GP cessation service and we tell staff where and how to signpost. (P53)

If [smoking cessation] is something that we are to focus on, it would be beneficial if there was a greater push from higher. There would be benefits to creating targets, providing training and more tools around how to support smoking cessation. (P26)

[We provide no training in smoking], we are more concerned with stopping them smoking crack. (P2)

 Staff smoking with service users

Staff and residents share a common smoking area in the hostel so there are no rules around smoking in front of residents. Code of conduct means staff cannot give cigarettes or any other form of smoking material/s to residents. (P17)

Staff smoke in the same place as service users and sometimes will be smoking at the same time. Smoking is sometimes used as a rapport building tool. (P29)

We find that cigarette smoking helps de-escalate a situation if a service user is becoming distressed. So a staff member will have a cigarette with the client. (P4)

It is not desirable to smoke in front of clients, however, if it is to get them to engage on common ground then it is acceptable in some circumstances. (P21)

 Lack of screening for smoking or screening for risk assessment only

[Service users] complete a survey upon entering a service, but smoking is not covered in this. We only cover smoking if the service users identify it themselves. (P2)

As part of their formal assessment when they first move in, there is a question about smoking, but this doesn’t always get asked. Sometimes it’s not appropriate ask service users about their smoking when they have really complex issues. (P26)

[Smoking] is usually on their referral. We are a no smoking hostel so it would be discussed with them when they move in. There is no smoking at all on site. This was decided after a large fire at the centre… (P17)