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Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia

  • Arusyak Harutyunyan (a1), Armine Abrahamyan (a1), Varduhi Hayrumyan (a1) and Varduhi Petrosyan (a1)

Abstract

Background

Despite compelling evidence that physicians play a prominent role in smoking cessation, most smokers do not receive the recommended smoking cessation counseling.

Aim

To identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia.

Methods

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.

Findings

Overall, 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.

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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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Arusyak Harutyunyan, MD, MPH, Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia. E-mail: aharutyunyan@aua.am

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