Why don’t they get help? An exploration of barriers to seeking help to quit smoking

Problem

The NHS Stop Smoking Services (SSS) were established to help smokers to quit smoking. However the proportion of smokers attending the SSS is less than 5%. A wide range of factors can deter smokers from seeking help, but more research is needed to assess in more depth the barriers to the use of the SSS and to explain this low attendance. The aim of the present study was to determine the most important barriers perceived by smokers that prevent them from seeking help to quit, specifically the SSS, and whether the barriers differed globally and according to demographic and smoking related characteristics.

Approach

Participants recruited to a large randomised controlled trial that aimed to encourage attendance at the SSS (the Start2quit study), but who reported that they did not attend (n=1597) were asked to complete the 36-item Treatment Barriers Questionnaire (TBQ), a US validated measure of reasons for not entering smoking cessation programmes, adapted for the UK. 758 participants completed and returned the questionnaire. Principal components analysis (PCA) was conducted to investigate the underlying structure of the data and to identify the key barriers to entering the SSS, and investigate whether the TBQ showed the same dimensions across different populations. Multiple regression analyses were used to determine whether any participant characteristics were associated with particular barriers.

Findings

The PCA, retaining 30 items with a factor loading >0.4, yielded seven factors explaining 53.06% of variance: 1) work and time constraints (5 items); 2) a belief that smokers should quit on their own (6 items); 3) a belief that nothing can help in quitting smoking (5 items); 4) disinterest in quitting (4 items); 5) lack of social support to attend (4 items); 6) lack of privacy at SSS programmes (2 items); 7) lack of information on SSS (4 items). Coefficient alphas ranged from 0.85 to 0.63 for the seven scales. Regression analyses showed that different characteristics were significantly associated with different factors. Specifically age, confidence in quitting, motivation, nicotine dependence and previous attendance at the SSS predicted endorsement of different factors. Smokers living in socially deprived areas and with other smokers were likely to experience a lack of social support.

Consequences

Results are consistent with previously identified barriers, and suggest that smokers may hold misconceptions about programmes of support, and underestimate their benefits. Some smokers may not be aware of existing SSS programmes. Identifying specific barriers to entering programmes can assist in the development of targeted strategies to overcome these barriers. Wider and more appropriate promotion to offer support at convenient times and places, and to attempt to dispel myths held by smokers regarding effectiveness can increase awareness of the support available and increase the numbers attending.