GP knowledge, attitudes, beliefs, and practices surrounding the prescription of e- cigarettes for smoking cessation: a protocol for a mixed- method systematic review

Background: Electronic cigarettes (e- cigarettes) are being marketed to people who smoke (PWS) as a smoking cessation aid. GPs have an important role in providing patients with support to encourage them to quit smoking. The emergence and marketing of e- cigarettes as a smoking cessation alternative poses challenges to GPs in advising and supporting PWS to quit. Aim: This systematic review aims to synthesise available evidence on the knowledge, attitudes, and perceptions of GPs about e- cigarettes as a smoking cessation aid. Design & setting: Mixed- methods study review including quantitative, qualitative, and mixedmethods studies of GPs in primary care settings. Method: MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, PsycINFO, and Embase databases will be searched to identify articles published between 1 January 2003 and 30 June 2021. A Google search will be conducted to identify grey literature. Two independent reviewers will screen abstracts for relevance and full- text studies. Articles will be appraised for quality using the Mixed Methods Appraisal Tool (MMAT) and a Preferred Reporting Items for Systematic Reviews, and Meta- Analysis (PRISMA) diagram will illustrate the flow of articles and reasons for exclusion. An evidence synthesis method will be employed and guided by the Theory of Planned Behaviour (TPB). A descriptive qualitative synthesis of the findings will be reported. Conclusion: Findings will provide a synthesis of current evidence regarding the knowledge, attitudes, and perceptions among GPs of e- cigarettes as a smoking cessation aid. This information will be useful to guide future research on the needs of GPs in advising and supporting patients to quit smoking. It will also assist in the development of health policy and guidelines on the role and place of e- cigarettes as a smoking cessation aid.