Investigating attitudes and framing moral responsibility in healthcare professionals for smoking cessation interventions

Objectives

Evidence-based support from healthcare professionals improves smoking cessation outcomes, yet intervention rates among UK general practitioners (GPs) remain suboptimal. This exploratory study explored whether framing messages around moral responsibility influences clinicians' intentions to offer smoking cessation support and explored their attitudes towards smoking.

Design

A between-subjects online experiment was conducted in May 2023 with 300 UK-based GPs and medical students.

Methods

Participants were randomised to one of three message conditions: professional obligation, shared responsibility, or neutral control. They rated their desire, duty, and intention to offer cessation support across clinical scenarios and completed attitude measures.

Results

Compared with control, professional obligation framing was associated with higher intention scores (β = .20, 95% CI [.01, .39]); shared responsibility showed no effect. Subgroup analyses suggested stronger effects among medical students. Contextual factors were influential: higher scores were observed for cardiovascular disease (β = .80) and bipolar disorder (β = .21), while time pressure and patient disinterest reduced intention (β = −.15 and −.14). Attitudes were mixed: 70% viewed smoking as a lifestyle choice, while 88% agreed addiction is a disease.

Conclusions

Professional obligation framing was associated with clinicians' intentions to offer cessation support, particularly among early-career clinicians. Attitudinal inconsistencies highlight a disconnect between clinicians' perceptions and public health guidance. Responsibility-based messaging may be promising for education and training. Given single-item outcomes and the exploratory design, findings should be interpreted cautiously and future work should examine measurement properties more rigorously.