“Once a smoker, always a smoker: Primary care physicians” views on integrating smoking cessation with antitubercular treatment in primary health centers – A qualitative study

Although smoking and tuberculosis (TB) pose a health threat in low- and middle-income countries, they are less recognized as public health problems. Lack of awareness among smokers about smoking cessation services and health-care professionals not viewing apparently – healthy smokers as the candidates for smoking cessation treatment are some of the significant barriers. This qualitative study explores the opinions and views of primary care physicians (PCPs) on integrating smoking cessation programs with the ongoing antitubercular treatment in primary health-care settings of India. The study employs a deductive qualitative design using a purposive sampling method to recruit physicians to implement the Directly Observed Treatment Short Course for TB patients in primary health-care settings. A semi-structured, open-ended questionnaire was developed based on the Consolidated Framework for Implementation Research to conduct in-depth interviews of eight PCPs. Although smoking cessation intervention is noticeable in the primary health centers, lack of uniformity in service deliverables, nonusage of nicotine replacement therapy, shortage of human resources, and meager readiness of the patients to quit smoking are a few encounters. PCPs advocate early identification of smokers, delegation of responsibilities to grassroots level health-care workers, and collaboration with the nongovernmental organizations and private sector.