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. 2017 Nov 13;16(1):196.
doi: 10.1186/s12939-017-0689-5.

"I'm not strong enough; I'm not good enough. I can't do this, I'm failing"- A qualitative study of low-socioeconomic status smokers' experiences with accesssing cessation support and the role for alternative technology-based support

Veronica C Boland  1 , Richard P Mattick  2 , Hayden McRobbie  3 , Mohammad Siahpush  4 , Ryan J Courtney  2
Affiliations

"I'm not strong enough; I'm not good enough. I can't do this, I'm failing"- A qualitative study of low-socioeconomic status smokers' experiences with accesssing cessation support and the role for alternative technology-based support

Veronica C Boland et al. Int J Equity Health. .

Abstract

Background: The social gradient in smoking rates persist with an overrepresentation of smoking and its associated harms concentrated within lower socioeconomic status (SES) populations. Low-SES smokers are motivated to quit but face multiple barriers when engaging a quit attempt. An understanding of the current treatment service model from the perspectives of treatment-seeking low-SES smokers is needed to inform the design of alternative smoking cessation support services tailored to the needs of low-SES populations. This qualitative study aimed to: i) explore low-SES smokers' recent quitting experiences; ii) assess factors that impact treatment engagement; and iii) determine the acceptability and feasibility of alternative approaches to smoking cessation.

Method: Low-SES participants (n = 24) previously enrolled in a smoking cessation RCT participated in either a semi-structured focus group or in-depth telephone interview. Data was obtained and analysed using thematic analysis from October 2015 to June 2016. Analysis was deductive from the interview guide and supplemented inductively.

Results: Participants expressed feelings of guilt and shame around their smoking behaviour and experienced stigmatisation for their smoking. Guilt, shame, and stigmatisation negatively impacted treatment seeking behaviours with most avoiding current quit services. Costs of pharmacotherapy and treatment adherence were commonly cited barriers to treatment success. Electronic-cigarettes were perceived to be unsafe due to uncertainty on their legal status and regulatory restrictions. Technology-based text-messaging quit support was endorsed as a more favourable alternative compared to existing behavioural treatment services.

Conclusion: Stigmatisation was commonly endorsed and acted as an impediment to current treatment utilisation. Electronic-cigarettes may present a viable harm reduction alternative, but their likely uptake in socioeconomically disadvantaged groups in Australia is limited by smokers' uncertainty about their regulation and legality. Mobile phone based cessation support may provide an alternative to telephone counselling and overcome the stigmatisation low-SES smokers face while trying to quit.

Keywords: Cessation support; Electronic cigarettes; Qualitative; Smoking cessation; mHealth.

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Conflict of interest statement

Ethics approval and consent to participate

The study received ethics approval from the University of New South Wales (UNSW) Human Research Ethics Committee (HC15523). Informed consent was obtained from all participants using the UNSW consent form approved by the UNSW ethics committee.

Consent for publication

Participants consented to their de-identified data being published at the time of informed consent via the institutional consent form.

Competing interests

HM has received investigator-led research funding and honoraria for speaking at educational meetings from Pfizer Inc. He has also received honoraria from Johnson and Johnson for speaking at educational meetings and an advisory board meeting. The remaining authors do not have a financial conflict of interest to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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