Implicit attribution of culpability and impact on experience of treating tobacco dependence

Abstract

Objective: Given the number of annual interactions between people who smoke and health care providers, even low-efficacy interventions would be expected to have a large cumulative effect on smoking prevalence. Efforts to improve uptake of tobacco dependence treatment guidelines have had limited success. It remains unclear whether complex social motivations influence treatment decision-making among providers, despite widespread understanding of the condition's impact on morbidity.

Method: Clinicians from across the United States participated in a computer-based survey of potential explicit tobacco treatment biases, relative to care of hypertension. Items corresponded to framework domains of Weiner's causal attribution theory of social motivation (Weiner, 1993). Single-word, open-response items were used to gain insight into the frequency of spontaneous perceptions regarding treatment of each condition. Implicit association testing (IAT) measured strength of association between images of smoking and evaluation of guilt versus innocence.

Results: Significant differences in agreement scores were identified within the causal attribution, emotional response, and help investment domains. Single-word answers confirmed a significant difference in emotional response to tobacco treatment (28.1% vs. 10.5%, p = .02), and suggested the difference was driven by the frequent perception of frustration (75% vs. 0%, p = .07). IAT revealed incompatibility between images of smoking and words conveying "innocence" compared with "guilt" (latency 1,846 ms vs. 1,113 ms, p < .001).

Conclusions: Complex social motivations may be operational in the context of tobacco dependence treatment, limiting provider willingness to follow treatment guidelines. If confirmed, this represents a critical obstacle to sophisticated guideline implementation, and should be addressed in future implementation strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Figure 1:

Is tobacco use “Sin or Sickness?” Weiner’s theory of social motivation, relating fundamental attribution error to clinician emotional response and effect on willingness to give help.(Weiner, 1993)

Figure 2:

Four Stage IAT designed to identify implicit associations between smoking status and evaluations of culpability. In Stage 1, the computer randomly presents words consistent with themes of guilt or innocence in the center of the screen. Respondents are asked to sort the words to the left or right side of the screen by depressing the ‘Q’ or ‘P’ keys with their left or right forefingers respectively. In Stage 2, respondents use the same technique to sort images of people, either smoking or not. Stage 3 requires sorting the hypothesized compatible evaluations to the same side of the screen, while Stage 4 requires similarly sorting the hypothesized incompatible evaluations. Latency time, measured from the moment of presentation to the moment of key stroke, are used to calculate the strength of implicit association between concepts. Credit: Getty Images.