Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia

Abstract

BackgroundDespite compelling evidence that physicians play a prominent role in smoking cessation, most smokers do not receive the recommended smoking cessation counseling.AimTo identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia.MethodsA sequential exploratory mixed-methods study was conducted among PHPs from two Armenian cities (Yerevan and Gyumri). We implemented qualitative phase through focus group discussions (FGDs) using a semi-structured guide. For the subsequent quantitative phase, the data were collected through cross-sectional survey. A directed deductive content analysis technique was used to analyze the FGDs and questionnaires were analyzed descriptively. Following the data collection (March 2015–May 2016) and descriptive analysis, the qualitative and quantitative data sets were merged by drawing quantitative data onto qualitative categories.FindingsOverall, 23 PHPs participated in five FGDs and 108 participants completed the survey. Three main categories of barriers were identified: physician-based, patient-based, and system-based barriers. The main physicians-based barriers were insufficient knowledge and inadequate training on tobacco-dependence treatment. Lack of patients’ motivation to quit, poor compliance with the treatment, patients’ withdrawal symptoms were identified as patient-based disincentives. System-based barriers included lack of reimbursement for providing smoking cessation counseling, high price and low availability of smoking cessation medications. Most of the qualitative descriptions were confirmed by quantitative findings.ConclusionsTargeted interventions are needed to address barriers that limited PHPs’ involvement in providing smoking cessation services in Armenia. There is an urgent need to enhance PHPs’ knowledge and skills in delivering smoking cessation counseling, to increase patients’ demand for smoking cessation services, and to ensure availability and affordability of smoking cessation services in Armenia.

Doctors’ smoking control knowledge, attitudes and practices: a cross-sectional study conducted in Shandong Province, China

“…However, approximately 60% of participants believed that providing smoking cessation assistance was their responsibility, which was also consistent with the findings of previous studies [7,20]. There were some possible explanations for the Secondly, most Chinese doctors thought that they were too busy to provide smoking cessation counseling [26], which also occurred in other countries [20]. The 5As method refers to 5 different counseling strategies for smoking cessation, including "Ask, Advise, Assess, Assist and Arrange" [12].…”

“…In this study, most participants (approximately 80%) realized their key role in smoking control, which was similar to the results of previous studies conducted in China and other countries [7,23,24]. However, approximately 60% of participants believed that providing smoking cessation assistance was their responsibility, which was also consistent with the findings of previous studies [7,20]. There were some possible explanations for the Secondly, most Chinese doctors thought that they were too busy to provide smoking cessation counseling [26], which also occurred in other countries [20].…”

“…Specific knowledge of the smoking-related harms associated with medical conditions can be learned in medical universities but the most common knowledge of smoking-related harms is learned in special training on smoking control. However, most participants did not receive special training on smoking control, which suggested a shortage of special training on smoking control for Chinese doctors and other countries' doctors [20][21][22]. As a result, doctors had little chance to learn the common knowledge of smoking-related harm.…”

“…On private occasions, the tradition of smoking has not changed fundamentally, and smoking is still treated as an individual freedom, which may result in the fact that few patients seek help for smoking cessation. Therefore, it is regarded as "offensive" and "harmful" for doctors to actively provide smoking cessation assistance [20]. Secondly, there is no requirement for doctors to actively provide smoking cessation assistance for smokers.…”

Smoking cessation knowledge, attitude and practices among tuberculosis physicians: A qualitative study

“…However, in Armenia, healthcare providers do not receive formal training on tobacco dependence treatment during medical education. It is well documented that lack of professional training impacts the provision of tobacco dependence treatment [18][19][20] . Our study, therefore, aimed to assess TB physicians' knowledge, attitude and practices (KAP), towards smoking cessation within TB care in Armenia to develop targeted interventions and effectively incorporate tobacco dependence treatment within routine TB services.…”