Abstract
Despite 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. A 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. Targeted 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.
Highlights
The tobacco epidemic is one of the biggest public health threats killing around 7 million people per year worldwide (World Health Organization, 2018)
Armenian primary healthcare physicians (PHPs) qualitatively distinguished between their roles in advising patients to quit smoking and providing smoking cessation assistance
The findings of our study indicated that the majority of Armenian PHPs were not aware of the smoking cessation guideline developed by the National Institute of Health
Summary
The tobacco epidemic is one of the biggest public health threats killing around 7 million people per year worldwide (World Health Organization, 2018). The major obstacles to achieving consistent tobacco dependence treatment include inadequate training (Abdullah and Husten, 2004; Jradi, 2015), lack of knowledge of smoking cessation pharmacotherapy (Young and Ward, 2001), lack of time (Abdullah et al, 2006; Blumenthal, 2007), heavy workload (Brotonsc et al, 2005), lack of incentives for providing smoking cessation services (Young and Ward, 2001; Brotonsc et al, 2005), and low Downloaded from https://www.cambridge.org/core. Aim: To identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia. Conclusions: Targeted 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
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