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Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers
  1. Andrea L Smith1,
  2. Stacy M Carter1,
  3. Simon Chapman2,
  4. Sally M Dunlop2,3,
  5. Becky Freeman4
  1. 1Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3Cancer Screening and Prevention, Cancer Institute NSW, Eveleigh, New South Wales, Australia
  4. 4Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Andrea L Smith; andrea.smith{at}sydney.edu.au

Abstract

Objective When tobacco smokers quit, between half and two-thirds quit unassisted: that is, they do not consult their general practitioner (GP), use pharmacotherapy (nicotine-replacement therapy, bupropion or varenicline), or phone a quitline. We sought to understand why smokers quit unassisted.

Design Qualitative grounded theory study (in-depth interviews, theoretical sampling, concurrent data collection and data analysis).

Participants 21 Australian adult ex-smokers (aged 28–68 years; 9 males and 12 females) who quit unassisted within the past 6 months to 2 years. 12 participants had previous experience of using assistance to quit; 9 had never previously used assistance.

Setting Community, Australia.

Results Along with previously identified barriers to use of cessation assistance (cost, access, lack of awareness or knowledge of assistance, including misperceptions about effectiveness or safety), our study produced new explanations of why smokers quit unassisted: (1) they prioritise lay knowledge gained directly from personal experiences and indirectly from others over professional or theoretical knowledge; (2) their evaluation of the costs and benefits of quitting unassisted versus those of using assistance favours quitting unassisted; (3) they believe quitting is their personal responsibility; and (4) they perceive quitting unassisted to be the ‘right’ or ‘better’ choice in terms of how this relates to their own self-identity or self-image. Deep-rooted personal and societal values such as independence, strength, autonomy and self-control appear to be influencing smokers’ beliefs and decisions about quitting.

Conclusions The reasons for smokers’ rejection of the conventional medical model for smoking cessation are complex and go beyond modifiable or correctable problems relating to misperceptions or treatment barriers. These findings suggest that GPs could recognise and respect smokers’ reasons for rejecting assistance, validate and approve their choices, and modify brief interventions to support their preference for quitting unassisted, where preferred. Further research and translation may assist in developing such strategies for use in practice.

  • QUALITATIVE RESEARCH
  • PUBLIC HEALTH
  • PREVENTIVE MEDICINE
  • PRIMARY CARE

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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