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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Implementing tobacco dependence treatment during clinical consultations: a qualitative study of clinicians’ experiences, perceptions and behaviours in a South African primary health care setting

BMC Family Practice > Ausgabe 1/2014
Olufemi B Omole, Olalekan A Ayo-Yusuf, Kabilabe NW Ngobale
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-85) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that there are no financial or personal relationships that may have inappropriately influenced the study.

Authors’ contributions

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).
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