Wanting to attend isn’t just wanting to quit: why some disadvantaged smokers regularly attend smoking cessation behavioural therapy while others do not: a qualitative study

Abstract

BackgroundAttendance of a behavioural support programme facilitates smoking cessation. Disadvantaged smokers have been shown to attend less than their more affluent peers. We need to gain in-depth insight into underlying reasons for differing attendance behaviour in disadvantaged smokers, to better address this issue. This study aims to explore the underlying motivations, barriers and social support of smokers exhibiting different patterns of attendance at a free smoking cessation behavioural support programme in a disadvantaged neighbourhood of The Netherlands.MethodsIn 29 smokers undertaking smoking cessation group therapy or telephone counselling in a disadvantaged neighbourhood, qualitative interviews were completed, coded and analysed. Major themes were motivations, barriers to attend and social support. Motivations and social support were analysed with reference to the self-determination theory.ResultsTwo distinct patterns of attendance emerged: those who missed up to two sessions (“frequent attenders”), and those who missed more than two sessions (“infrequent attenders”). The groups differed in their motivations to attend, barriers to attendance, and in the level of social support they received. In comparison with the infrequent attenders, frequent attenders more often had intrinsic motivation to attend (e.g. enjoyed attending), and named more self-determined extrinsic motivations to attend, such as commitment to attendance and wanting to quit. Most of those mentioning intrinsic motivation did not mention a desire to quit as a motivation for attendance. No organizational barriers to attendance were mentioned by frequent attenders, such as misunderstandings around details of appointments. Frequent attenders experienced more social support within and outside the course.ConclusionMotivation to attend behavioural support, as distinct from motivation to quit smoking, is an important factor in attendance of smoking cessation courses in disadvantaged areas. Some focus on increasing motivation to attend may help to prevent participants missing sessions.

Treatment attrition: Associations with negative affect smoking motives and barriers to quitting among treatment-seeking smokers

“…Given the low success rate of smoking cessation (Centers for Disease Control and Prevention [CDC], 2002), clinicians could use a smokers rating for negative affect reduction smoking motives and classify smokers who may be in the greatest need of additional support. Indeed, providing psychoeducation using motivational techniques on the importance of attending treatment to these smokers may yield increased treatment attendance rates (Benson, Stronks, Willemsen, Bogaerts, & Nierkens, 2014), and subsequently enhance outcomes.…”

Predictors of participant ‘no-shows’ for intensive behavioral tobacco cessation treatment: recruitment, demographics, and distance

“…Previous studies have examined factors associated with initial engagement in behavioral tobacco cessation intervention trials. Evidence suggests that younger smokers (Woods et al, 2002), racial/ethnic minorities (Audrain-McGovern, Halbert, Rodriguez, Epstein, & Tercyak, 2007), and lower socioeconomic status individuals (Benson, Stronks, Willemsen, Bogaerts, & Nierkens, 2014;Woods et al, 2002) are less likely to show for tobacco treatment. Additional barriers to attendance include lack of transportation, work-schedule conflicts, and low motivation to quit (Kale, Gilbert, & Sutton, 2019;Woods et al, 2002).…”

Effects of different types of smoking cessation behavioural therapy in disadvantaged areas in the Netherlands: an observational study.

“…While both individual forms are more flexible than group counselling, allowing appointments to be scheduled when suitable for the participant, telephone counselling is very flexible, as a participant does not have to be present in a certain place at a certain time 15 and can possibly reschedule appointments at short notice 11 . This may be suited to people who find it difficult to attend set appointments in person, such as mothers with little support or people with busy or irregular jobs 11 . However, some smokers may be suspicious about the confidentiality of such a service or may not be able to envision themselves being helped over the telephone 15 …”

“…This has the advantage of the group being able to develop a strong social support network as they see each other regularly. However, it can mean waiting to start 13 and, if there is a high level of drop-out, participants may feel demotivated as the group gets smaller 11 . Rolling group counselling (also called open group), involves the continuous sequential repetition of sessions throughout the year.…”

“…Group counselling, provided to a group of smokers by a trained smoking cessation counsellor, provides the opportunity for participants to experience group support and social learning 8,9 but can also possibly lead to demotivation due to unhelpful group processes (e.g. rivalry, envy, fear of failure/loss of face) 8,11,12 . Group counselling can be provided in a fixed group or rolling group format.…”