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

Research Article

Kabilabe NW Ngobale¹  Olufemi B Omole¹  Olalekan A Ayo-Yusuf² 

[1] Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;School of Health Systems & Public Health, University of Pretoria, PO Box 1266, 0001, Pretoria, South Africa;Director’s Office, School of Oral Health Sciences, University of Limpopo, MEDUNSA Campus, Pretoria, South Africa;

关键词: Healthcare provider;    Behaviours;    Primary care;    Tobacco dependence treatment;   

DOI  :  10.1186/1471-2296-15-85

 received in 2013-07-07, accepted in 2014-04-30,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundEvidence 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.MethodsIndividual 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.ResultsFifteen 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.ConclusionThe 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).

【 授权许可】

Unknown   
© Omole et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.