Tobacco (42) Q2. Do health workers have adequate knowledge to prevent and treat tobacco addiction? (4)

7 March, 2023

See our article from 2014 - not enough has changed: [*see note below]

FPs’ lack of training in smoking cessation skills

During the focus group and interviews, questions that explored the FPs’ professional knowledge received a variety of responses. The need for additional training was universally acknowledged. The general lack of education about smoking cessation during undergraduate and postgraduate training was highlighted, as well specific uncertainties about pharmacotherapy.

They [courses] would be welcome because neither during the university nor later, nobody teaches us. (FP 11, interview)

You know, all this tobacco related stuff is relatively new (...) so, as long as people are interested in quitting, yes, training is welcome. (FP 31, interview)

I have heard, of course, about nicotine gum, varenicline and electronic cigarettes, but I am not very sure which should be prescribed to whom. (FP 8, focus group)

Many participants agreed that they felt unprepared, especially when they had to assist patients who had relapsed. One FP expressed their frustration and uncertainty about how to help ‘the type of patient, who has tried everything? No matter what you say to the smoker, he has already tried and decided it will not work’. (FP 2, focus group).


PS - for the discussion week on health perceptions: colleagues have just published something different on young people’s perception of heated tobacco products

HIFA profile: Sian Williams is Chief Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. AT

[*Note from HIFA moderator (NPW): Below are the citation and abstract of the 2014 paper:

Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians

Catalina Panaitescu, Mandy A Moffat, Siân Williams, Hilary Pinnock, Melinda Boros, Cristian Sever Oana, Sandra Alexiu & Ioanna Tsiligianni

npj Primary Care Respiratory Medicine volume 24, Article number: 14022 (2014)


Background: Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs).

Aim: To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients.

Methods: A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced.

Results: Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients’ inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care.

Conclusions: Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption.]