A qualitative study exploring barriers and facilitators to presenting to primary care among smokers

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The problem

The UK has the highest perceived barriers to symptomatic presentation of cancer symptoms and low awareness of age-related risk compared to other higher-income countries. Smoking is the cause of several cancers and the most avoidable cancer risk factor. Consequently help-seeking behaviour among smokers and their understanding and knowledge of potential cancer symptoms is important to investigate. The main research question was: What are the barriers and facilitators for smokers in presenting with cancer-related symptoms to primary care when there is a new or perceived change in respiratory or head and neck symptoms?

The approach

We purposively sampled a subset of respondents from a large general practice based questionnaire study of smokers and non-smokers who had agreed to be interviewed. These were smokers over the age of 50 years recruited from GP lists in Yorkshire and their social contacts (spouse/partner/friend). We interviewed 38 people; of these 29 were participants (mostly smokers although a few had either reduced or stopped smoking at the time of the interview) and 9 were social contacts (their smoking status was varied). Six of the social contact interviews were joint interviews as it was convenient to interview the participant and their social contact at the same time. We conducted in-depth interviews either at the GP practice or the interviewee's home and explored issues around smoking behaviour and attempts to give up? perceptions of health and illness, experience of symptoms, health-seeking behaviour including contact with health care, influence of others in presenting symptoms? experience and perceptions of smoking cessation awareness both in general and in healthcare interactions. Interviews were recorded and transcribed. A coding framework and NVivo were used during the data analysis to inform a thematic analysis. Regular discussions were held by the research team.


Preliminary findings suggest both barriers and facilitators to presentation in primary care. Barriers include not taking potential cancer symptoms seriously, a lack of awareness of potential cancer symptoms, a lack of awareness of the effect of smoking on health or symptoms, influence of social contacts, health beliefs, not wanting to bother the doctor and having a poor relationship with the health service. Facilitators include impact of symptoms on daily life, having a smoking-related condition, cancer experience and influence of social contacts. Some factors, for example, the influence of social contacts, emerged as both barriers and facilitators depending on the context. Consequence In order to improve the UK cancer outcomes, there is need to work towards eliminating or reducing the barriers to presentation to primary care. Targeted interventions to increase awareness of potential cancer symptoms among smokers over fifty years should be considered.


  • Julie Walabyeki, University of York, York, UK
  • Karl Atkin
  • Joy Adamson
  • Hilary Graham
  • Una Macleod, University of York, York, UK