Exploring healthcare professionals’ experiences and perspectives on cessation support for people who use non-cigarette tobacco: a qualitative study
Eve Taylor, Harry Tattan-Birch, Jamie Brown, Lion Shahab, Sharon Cox, Masuma Pervin Mishu, Katherine East, Hazel Cheeseman, Sarah JacksonIntroduction
Healthcare services in England often support cigarette smoking cessation, yet little is known about how healthcare professionals support people to quit who use other non-cigarette tobacco products, such as cigars, cigarillos, shisha and different forms of chewing tobacco. This study explored healthcare professionals’ (1) experiences of providing cessation support for non-cigarette tobacco, (2) perceived barriers and facilitators and (3) suggestions for improving service provision.
Methods
Four semistructured focus groups and interviews were conducted with (N=19) specialist (tobacco dependence advisors) and non-specialist (eg, pharmacist, nurse) healthcare professionals who have experience in providing smoking cessation support across England. Data were analysed using iterative categorisation with thematic analysis.
Results
Healthcare professionals vary in their experiences supporting people to stop using non-cigarette tobacco products, usually depending on the demographic composition of the local community. Professionals who regularly engage with people who use non-cigarette tobacco described a range of tailored support provided, such as behavioural support, nicotine replacement therapy and vapes. Structural barriers to providing support included screening tools that only ask about ‘smoking’, commissioning that restricts services to cigarette use, and limited training and resources for non-cigarette products. Professional barriers included low confidence in supporting cessation due to a lack of official guidance on these products. Recommendations to improve services included adapting screening tools to capture non-cigarette tobacco use, expanding service eligibility to all tobacco users, developing culturally tailored resources and strengthening community partnerships to improve outreach.
Conclusions
In a sample of healthcare professionals in England, there was substantial variation in the provision of, and healthcare professionals’ confidence in providing, support for non-cigarette tobacco cessation. Amending screening tools, developing clinical training and guidelines and expanding access to services for all types of tobacco use could improve support provision and improve treatment equity.