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

摘要

BACKGROUND : Evidence suggests that healthcare providers (HCPs) in South Africa do not consistently offer tobaccodependence treatment (TDT) during clinical consultations. In order to understand and explain this behaviour in aSouth African context, we conducted a qualitative exploration of HCPs’ experiences, perceptions and behavioursregarding TDT.METHODS : Individual qualitative interviews were conducted with physicians and nurses who were purposivelyselected. Themes were identified from interview transcripts using content analysis. Findings were triangulated andpeer-reviewed, and were also verified by the participants.RESULTS : Fifteen physicians and four nurses were interviewed, none of whom used tobacco. These participantsperceived TDT as an important task, but could not consistently implement it during clinical consultations due to healthsystems constraints (time-constraints because of patient-overload, the unavailability of cessation medications and a lackof support for referrals), misperceptions and misconceptions (negative outcome expectations about the effectivenessand feasibility of TDT), socio-cultural barriers (counselling older persons was perceived as challenging) and personallimitations (perceived low self-efficacy, poor knowledge and skills on implementing any evidence-based TDTframework). Patients are therefore selectively screened based on clinical relevance and offered only prescriptivebrief advice. Participants recommended several systems changes, including academic detailing of tobacco status,training HCPs and incorporating tobacco cessation medications in the Essential Drug List.CONCLUSION : The reported selective screening and limited TDT interventions offered by HCPs are related to interactionsbetween health systems constraints, personal limitations, and misperceptions and misconceptions about the effectivenessand feasibility of TDT during clinical consultation. Implementing the recommended systems changes has the potential toimprove the implementation of TDT in South African primary health care (PHC).