Perceived feasibility of a primary care intervention for Tobacco Cessation on Prescription targeting disadvantaged groups in Sweden: a qualitative study

Abstract

BackgroundThere is a lack of scientific evidence on how socioeconomically disadvantaged tobacco users can be reached with tobacco cessation interventions in Swedish primary healthcare (PHC). In this setting other lifestyle interventions are available by prescription, and there is the potential to develop a similar tool for tobacco cessation. The aim of this study was thus to explore the perceived feasibility and optimal design of Tobacco Cessation on Prescription (TCP) in PHC, targeting disadvantaged groups in Sweden.MethodsThis qualitative study is based on semi-structured interviews with 32 participants including (1) three experts in lifestyle interventions on prescription, (2) 14 healthcare providers and (3) 15 clients from three PHC centres in socioeconomically disadvantaged areas in Stockholm where tobacco use is high. The interviews were audio-recorded and transcribed verbatim. The manifest content of the transcripts was analysed according to a modified conventional approach to content analysis.ResultsThe interviewees proposed that TCP should include a template comprising the client’s information, evidence-based tobacco cessation options and choices for follow-up. They also suggested including information about the benefits of tobacco cessation, as well as empowerment and planning support tools. The participants also commented that other measures for tobacco cessation could be included on the prescription. From the clients’ point of view, the perceived advantages of TCP were often linked to an emotional meaning (e.g. increased motivation to quit tobacco use, sign of support from the healthcare system to seek care for tobacco cessation). For providers, advantages with TCP were frequently related to a practical meaning (e.g. improved documentation and facilitation of tobacco cessation treatment). The disadvantages identified were mainly connected with the future implementation of TCP (e.g. low self-efficacy among clients and providers).ConclusionsTCP was perceived to be a useful tool for both clients and providers, potentially facilitating a structured and effective approach to tobacco cessation in PHC, and targeting disadvantaged groups. More research is needed to develop the prescription and investigate its effectiveness and cost-effectiveness compared to current strategies for tobacco cessation in a PHC setting.

A Cluster-Randomized Controlled Trial Evaluating the Effectiveness and Cost-Effectiveness of Tobacco Cessation on Prescription in Swedish Primary Health Care: A Protocol of the Motivation 2 Quit (M2Q) Study

“…Since community involvement in intervention design has been found to have positive effects on the uptake of an intervention [ 32 ], this is expected to have a positive effect on the effectiveness and acceptability of TCP. Results from the previously mentioned study that explored the perceived feasibility and optimal design of TCP suggest that there is support for the method [ 22 ].…”

“…In the TCP method, the components in PAP have been adjusted to the tobacco cessation context (see conceptual model in Figure 2 and full description of the core components below). The initial TCP prescription form was drafted by the researchers based on the national guidelines for tobacco cessation treatment in Sweden [ 1 ] and the results from the qualitative study that explored the perceived feasibility and optimal design of TCP [ 22 ]. The prescription form was then further developed based on an iterative process of feedback from waiting room interviews with patients, as well as workshops and written correspondence with health care providers, researchers and experts on tobacco cessation and lifestyle interventions already available by prescriptions in Sweden.…”

“…In a recent study, the perceived feasibility and optimal design of Tobacco Cessation on Prescription (TCP) as a PHC intervention targeting disadvantaged groups in Sweden, was explored [ 22 ]. The study found that TCP was perceived as a useful tool for tobacco users and health care providers and that it could facilitate a more structured and effective approach to tobacco cessation in the future compared to current tobacco cessation practices in PHC [ 22 ]. Based on these findings, there is now a hypothesis that TCP could be implemented and prescribed in a similar manner as Physical Activity on Prescription (PAP).…”

Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas

“…Tobacco Cessation on Prescription (TCP) is a new PHC intervention that could facilitate tobacco cessation in Swedish PHC [16]. It is inspired by Physical Activity on Prescription (PAP), which is a physical activity referral scheme that has been found effective in increasing physical activity and improving health and quality of life in the general population in Sweden since 2001 [17].…”

“…It is inspired by Physical Activity on Prescription (PAP), which is a physical activity referral scheme that has been found effective in increasing physical activity and improving health and quality of life in the general population in Sweden since 2001 [ 17 ]. TCP has been developed based on PAP, on the findings from a qualitative study that explored the perceived feasibility and optimal design of TCP [ 16 ] and on clinical guidelines for tobacco cessation in Sweden [ 18 ]. It consists of counseling for at least 10 minutes, an individualized prescription of tobacco cessation treatment with options for further counseling (referral to a health care provider with more competence or the Swedish National Tobacco Quitline), pharmacotherapy (nicotine replacement therapy, varenicline, bupropion), other measures for cessation (physical activity, strategies to cope with withdrawal symptoms), support for self-management (questions for self-reflection, reference to mobile applications and websites) and follow-up (by telephone or revisit) on at least one occasion [ 19 ].…”