title: Smoke-free homes: what are the barriers, motivators and enablers? A qualitative systematic review and thematic synthesis.
abstract: OBJECTIVE
  To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs).
  
  
  METHODS
  Systematic review and thematic synthesis.
  
  
  METHODS
  Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists.
  
  
  METHODS
  We included 22 articles, reporting on 18 studies, involving 646 participants.
  
  
  METHODS
  peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants' perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH.
  
  
  METHODS
  1 of 3 authors extracted data with checking by a second.
  
  
  RESULTS
  A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities.
  
  
  CONCLUSIONS
  This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs.
  
  
  BACKGROUND
  CRD42014014115.
authors.affiliation: University Centre for Rural Health-North Coast, School of Public Health, University of Sydney, Lismore, New South Wales, Australia.
authors.forename: Megan E
authors.identifier: http://orcid.org/0000-0001-5766-0235
authors.initials: ME
authors.lastname: Passey
authors.affiliation: University Centre for Rural Health-North Coast, School of Public Health, University of Sydney, Lismore, New South Wales, Australia.
authors.forename: Jo M
authors.identifier: http://orcid.org/0000-0002-8257-7772
authors.initials: JM
authors.lastname: Longman
authors.affiliation: Department of Sociology, Social Policy and Criminology, School of Law and Social Justice, University of Liverpool, Liverpool, UK.
authors.forename: Jude
authors.initials: J
authors.lastname: Robinson
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
authors.affiliation: UK Centre for Tobacco and Alcohol Studies & Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Laura L
authors.identifier: http://orcid.org/0000-0002-4018-3855
authors.initials: LL
authors.lastname: Jones
mesh_terms: D006798:Housing; D006801:Humans; D009042:Motivation; D036301:Qualitative Research; D061845:Smoke-Free Policy; D012907:Smoking / Q000009:adverse effects*; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D035862:Vulnerable Populations
chemical_list: D014028:Tobacco Smoke Pollution
keywords: QUALITATIVE RESEARCH; secondhand smoke; smoke-free homes; systematic review; thematic synthesis