The online version of this article (doi:10.1186/1471-2296-15-85) contains supplementary material, which is available to authorized users.
The authors declare that there are no financial or personal relationships that may have inappropriately influenced the study.
OB was involved in the conception, design, data analysis and interpretation of the results, drafting and revision of the manuscript, and has given approval for this version of the paper to be published. OA was involved in the conception, design, data analysis and interpretation of results, revision of the manuscript and has given final approval for the final version to be published. KNW was involved in the conception, design, data analysis and interpretation of results and has given approval for the final version to be published. All authors read and approved the final manuscript.
Evidence suggests that healthcare providers (HCPs) in South Africa do not consistently offer tobacco dependence treatment (TDT) during clinical consultations. In order to understand and explain this behaviour in a South African context, we conducted a qualitative exploration of HCPs’ experiences, perceptions and behaviours regarding TDT.
Individual qualitative interviews were conducted with physicians and nurses who were purposively selected. Themes were identified from interview transcripts using content analysis. Findings were triangulated and peer-reviewed, and were also verified by the participants.
Fifteen physicians and four nurses were interviewed, none of whom used tobacco. These participants perceived TDT as an important task, but could not consistently implement it during clinical consultations due to health systems constraints (time-constraints because of patient-overload, the unavailability of cessation medications and a lack of support for referrals), misperceptions and misconceptions (negative outcome expectations about the effectiveness and feasibility of TDT), socio-cultural barriers (counselling older persons was perceived as challenging) and personal limitations (perceived low self-efficacy, poor knowledge and skills on implementing any evidence-based TDT framework). Patients are therefore selectively screened based on clinical relevance and offered only prescriptive brief advice. Participants recommended several systems changes, including academic detailing of tobacco status, training HCPs and incorporating tobacco cessation medications in the Essential Drug List.
The reported selective screening and limited TDT interventions offered by HCPs are related to interactions between health systems constraints, personal limitations, and misperceptions and misconceptions about the effectiveness and feasibility of TDT during clinical consultation. Implementing the recommended systems changes has the potential to improve the implementation of TDT in South African primary health care (PHC).
World Health Organization: WHO Global Report: Mortality Attributable to Tobacco. 2012, Geneva, Switzerland: WHO, http://whqlibdoc.who.int/publications/2012/9789241564434_eng.pdf?Ua=1. Accessed 15/03/2014
Zwar N: Smoking cessation. What works?. Aust Fam Physician. 2008, 37: 10-14. PubMed
Saloojee Y, Steyn K: Educating medical students about tobacco. S Afr Med J. 2005, 95: 330-331. PubMed
Everett K, Odendaal HJ, Steyn K: Doctors’ attitudes and practices regarding smoking cessation during pregnancy. S Afr Med J. 2005, 95: 350-354. PubMed
Saywell RM, Jay SJ, Lukas PJ, Casebeer LL, Mybeck KC, Parchman ML, Haley AJ: Indiana family physician attitudes and practices concerning smoking cessation. Indiana Med. 1996, 89: 149-156. PubMed
Thankappan KR, Pradeepkumar S, Nichter M: Doctors’ behaviour and skills for tobacco cessation in Kerala. Indian J Med Res. 2009, 129: 249-255. PubMed
Social Cognitive Theory. University of Twente 2010. http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Health%20communication/Social_Cognitive_theory/. Accessed 30/07/2012
Redmond BF: Self-efficacy and Social Cognitive Theories. http://wikispaces.psu.edu/display/PSYCH484/7.+Self-Efficacy+and+Social+Cognitive+Theories. Accessed 01/05/2013
Shields E, Department of Health, Bureau of Health Promotion, Tobacco Prevention and Control Program: Barriers to Tobacco Cessation Counselling Among Health Care Providers in Utah. Utah: Department of Health, Bureau of Health Promotion, Tobacco Prevention and Control Program, 1-20. [ http://www.tobaccofreeutah.org] Accessed 13/06/2010
Abartemarco DJ, Steinberg MB, Delnevo CD: Midwives’ knowledge, perceptions, belief, and practice supports regarding tobacco dependence treatment. J Midwifery Womens Health. 2007, 52: 451-457. 10.1016/j.jmwh.2007.03.019. CrossRef
Jaen CR, Stange KC, Tumiel LM, Nutting P: Missed opportunities for prevention: smoking cessation counselling and the competing demand of practice. J Fam Pract. 1997, 45: 348-354. PubMed
Chandwani BP, Perry B, Scrivani S, Kulich RK: Smoking cessation in the dental setting: a practical approach. Gen Dent. 2010, 58: 318-323. PubMed
Johns TL, Lawrence E, Martini LE, Dunn GE, Thompson ZJ, Zwygart K: Smoking cessation in Family medicine: effects of an area Health Education Center training program. J Grad Med Edu. 2010, 2: 283-288. 10.4300/JGME-D-10-00043.1. CrossRef
Brunnhuber K, Cummings KM, Feit S, Sherman S, Woodcock J: Putting evidence into practice: smoking cessation. BMJ. 2007, 1-40. Available online at http://www.semejnamedicina.mednet.mk/upload/dok/582_847756324.pdf. Accessed 18/04/2014
Mcllvain HE, Backer EL, Crabtree BF, Lacy N: Physician attitudes and the office-based activities for tobacco control. Fam Med. 2002, 43: 114-119.
Omole OB, Ogunbanjo GA: Smokeless tobacco: is it really safe?. SA Fam Pract. 2009, 51: 292-295.
Walsh SE, Singleton JA, Worth CT, Krugler J, Moore R, Wesley GC, Mitchell CK: Tobacco cessation counselling training with standardized patients. J Dent Edu. 2007, 71: 1171-1178.
Martin BA, Bruskiewitz RH, Chewning BA: Effect of a tobacco cessation continuing professional education program on pharmacists’ confidence, skills and practice-change behaviour. J Am Pharm Assoc. 2010, 50: 9-16. 10.1331/JAPhA.2010.09034. CrossRef
McDaniel AM, Stratton RM: Internet based smoking cessation initiatives. Availability, varieties, and likely effects of outcomes. Dis Manage Health Outcomes. 2006, 14: 275-285. 10.2165/00115677-200614050-00003. CrossRef
- Implementing tobacco dependence treatment during clinical consultations: a qualitative study of clinicians’ experiences, perceptions and behaviours in a South African primary health care setting
Olufemi B Omole
Olalekan A Ayo-Yusuf
Kabilabe NW Ngobale
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II