Abstract
Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.
Highlights
Rural–remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas
This study found that implementing a smoking cessation intervention in rural–remote communities is challenged by the following: limited health service resources, collaboration and accessibility, high levels of community distress, mental illness and disadvantage, normalisation of smoking, and low staff morale
The present study indicates that health staff implementing whole-of-community anti-smoking programs in rural–remote Australia encounter a number of challenges including limited primary and mental healthcare resources, collaboration and accessibility; high levels of community distress, smoking and disadvantage; and low staff morale
Summary
Rural–remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural–remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural–remote Australia. In rural–remote Australia, government-controlled primary healthcare (PHC) services, such as hospital outpatient and primary health services, are well placed to deliver clinicbased anti-smoking programs because they provide multidisciplinary care, target whole communities and are located in the communities they serve[3]. While clinic-based anti-smoking programs are effective tobacco treatments[4,5], little is known of the challenges encountered and strategies employed when implementing such programs through rural– remote PHC services
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