Motivations toward smoking cessation, reasons for relapse, and modes of quitting: results from a qualitative study among former and current smokers.

BACKGROUND: Smoking cessation plays a crucial role in reducing preventable morbidity and mortality and is a recognized public-health-policy issue in many countries. Two of the most important factors that affect the efficacy of quitting smoking are motivation and the ability to cope with situations causing relapse. AIM: The objective of the study reported here was to investigate former and current smokers' motivations for smoking cessation, reasons for relapse, and modes of quitting. METHODS: We arranged four focus groups with 24 participants (twelve current and twelve former smokers) and eleven semi-structured interviews (five current and six former smokers) with a view to understanding and categorizing their opinions on motivations and the course and process of smoking cessation. The data were next analyzed using descriptive qualitative methods. RESULTS: THREE MAIN THEMES WERE IDENTIFIED: (1) motivations to quit smoking, (2) reasons why smokers sometimes relapse, and (3) modes of quitting smoking. Within the first theme, the following six subthemes surfaced: (1) a smoking ban at home and at work due to other people's wishes and rules, (2) the high cost of cigarettes, (3) the unpleasant smell, (4) health concern, (5) pregnancy and breastfeeding, and (6) a variety of other factors. The second theme encompassed the following subthemes: (1) stress and the need to lessen it by smoking a cigarette, (2) the need to experience the pleasure connected with smoking, and (3) the smoking environment both at home and at work. Participants presented different smoking-cessation modes, but mainly they were unplanned attempts. CONCLUSION: Two very important motivations for smoking cessation were a smoking ban at home and at work due to other people's wishes and rules, and the high cost of cigarettes. The most common smoking-cessation mode was a spontaneous decision to quit, caused by a particular trigger factor. Relapse causes encompassed, most notably: stress, lack of the pleasure previously obtained from smoking, and the smoking environment.

"What kind of general practitioner do I need for smoking cessation?" Results from a qualitative study in Poland.

BACKGROUND: Cigarette smoking remains the leading preventable cause of death and disease. Thus, all activities aiming to reduce smoking play an important role in improving population health. The positive role of the general practitioner (GP) in smoking cessation could increase the success rate for quitting smoking, if compared with unassisted cessation. The aim of this study was to determine what kind of general practitioner smokers need in order to stop smoking. METHODS: Four focus groups with 12 current and 12 former smokers (aged 20-59, 11 women and 13 men), were arranged in the city of Torun, Poland, with a view to describe their opinions on the GP's role in smoking cessation. The data were subjected to descriptive qualitative content analysis. RESULTS: Two major themes emerged in the analysis: the smokers' positive and negative experiences of the GP in smoking cessation and their expectations regarding the role of the GP in smoking cessation. The first theme embraced the following subthemes: (1) GP's passivity, (2) routine questions about the patient's smoking during the visit, (3) lack of time during the visit, and (4) the role model of the GP in smoking cessation. Within the second theme, the respondents identified the following subthemes: (1) bringing up the topic of smoking cessation, even in situations when the patient is unprepared for this; (2) the necessity of a tailored approach to the patient; (3) access to information and evidence confirming the harms of smoking tobacco; (4) prescription of pharmacological and other treatment; and (5) referral to specialists in smoking cessation. CONCLUSIONS: Patients expect their GP to actively participate in smoking cessation through a more tailored approach to the patient's needs. The patients' experiences did not match their expectations: the smokers rarely got advice on smoking cessation from their GPs. Finally, they emphasized the importance of the GP as a role model in smoking cessation.

Challenges in the management of patients with medically unexplained symptoms in Poland: a qualitative study.

BACKGROUND: Patients with medically unexplained symptoms (MUS) are highly prevalent in primary care. There are no guidelines for treatment and management of this group of patients in the Polish health care system and the establishment of a long-term doctor-patient relationship, which is the crux of the therapy, is impeded. OBJECTIVE: To establish what challenges Polish GPs encounter while dealing with patients with MUS. METHOD: A thematic analysis of 4 focus groups (14 GPs altogether), using a three-level coding of data. RESULTS: Three main themes surfaced in the analysis: negative emotions among the investigated GPs, their insufficient training in the management of patients with MUS and the lack of guidelines and the influence of the changed health care environment on the management of patients with MUS. Four major influences of the changed health care environment emerged: GPs' negative image as professionals, barriers to building a continuous doctor-patient relationship, limited resources and limited access to specialists and lack of a multidisciplinary primary care team. CONCLUSIONS: Treatment and management of patients with MUS should make provision for a personalized approach to the patient within the Polish primary health care system. This can be enhanced by providing additional training in the biopsychosocial model during medical education and establishing a GP multidisciplinary team. Allocating increased financial resources for primary health care and facilitating access to psychologists and psychotherapists could also prove beneficial.