Barriers to smoking cessation: a qualitative study from the perspective of primary care in Malaysia

Abstract

ObjectivesThis qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting.DesignIndividual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method.Participants and settingFifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included.ResultsA five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception: perception among smokers that ability to quit was solely based on one’s ability to achieve mind control, and perception that stopping smoking will harm the body and (5) Failed assisted smoking cessation: smoking cessation services were not felt to be user-friendly and were poorly understood. The themes were organised into five concentric circles based on time frame: those actionable in the short term (themes 1 and 2) and the long term (themes 3, 4, 5).ConclusionsFive themes of specific beliefs and practices prevented smokers from quitting. Clinicians need to work on these barriers, which can be guided by the recommended time frames to help patients to succeed in smoking cessation.

When primary care providers and smokers meet: a systematic review and metasynthesis

“…Finally, many patients expected an active role from PCPs 49 , 50 : to give advice to every patient about smoking 46 – 48 , 51 and to provide education, information, and smoking cessation options 41 , 49 . Some patients explained that they were too ashamed to admit they were smoking and would not be able to raise the issue by themselves 49 .…”

“…Some patients explained that they were too ashamed to admit they were smoking and would not be able to raise the issue by themselves 49 . According to the patients, general practitioners (GPs) were at the best place to initiate the process—better than specialized clinics-, since they knew the patients the best and had an established ongoing relationship with them 41 , 46 , 51 , 52 .…”

“…Both patients and PCPs underlined the impact of finding the right moment to speak about smoking cessation, that is either when the patient was ready to speak about it 48 , 55 or when the context of the consultation made it a relevant issue to address, for instance when patients had a disorder potentially aggravated by smoking, such as asthma, cardiovascular diseases, diabetes, or periodontal problems 41 , 42 , 51 , 56 . The authors described the concept of a ‘teachable moment’ 56 .…”

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“…consequentemente a maior causa de falha na cessação do tabagismo, pois a dependência é o elemento central na manutenção do tabagismo. [17][18][19] A dependência da nicotina possui dois componentes básicos: o físico (desejo intenso de fumar, sintomas de abstinência) e o psicológico (apoio para lidar com situações de solidão, estresse e frustrações). Assim, pessoas com baixa dependência tem menor frequência e intensidade de sintomas de abstinência, logo apresentam maiores chances de sucesso na cessação do tabagismo.…”

Effectiveness of community health workers involvement in smoking cessation programme: A systematic review

“…The WHO has developed an effective community-based strategy to reduce the gap in healthcare in low-socioeconomic areas. However, the current smoking cessation services are not user-friendly and poorly understood [ 16 ].…”