title: A qualitative exploration of the reasons for the discontinuation of smoking cessation treatment among Quit Smoking Clinics' defaulters and health care providers in Malaysia.
abstract: BACKGROUND
  Treatment default among the smokers hinders the effectiveness of the delivery of cessation services. While many studies have predicted the defaulters' characteristics, the reasons why these smokers dropped out and continued smoking are seldom explored.
  
  
  OBJECTIVE
  This study examined the barriers encountered by such smokers and their respective health care providers (HCPs) in relation to the discontinuation of cessation treatment.
  
  
  METHODS
  From May 2010 to March 2011, 15 current adult smokers and 9 HCPs from 2 Quit Smoking Clinics (QSCs) in the Melaka Tengah District, Malacca, Malaysia were interviewed on smoking, cessation, and the QSC. Interviews were audio recorded and transcribed verbatim. The transcripts were subsequently translated into English and analyzed using thematic analysis.
  
  
  RESULTS
  The barriers encountered were categorized as Individual- and Clinic-level. Both smokers and HCPs acknowledged that the smokers' low intrinsic motivation was the individual-level barrier. The clinic-level barriers were the mismatched perceptions of smokers and HCPs regarding the HCPs' roles, skills, and attitudes, as well as the availability and efficacy of smoking cessation aids (SCAs). While the smokers viewed the program as not helpful, the HCPs cited the lack of organizational support as their main barrier.
  
  
  CONCLUSIONS
  The reasons for treatment default centered on the overall dissatisfaction with the treatment (due to the program, HCP, and SCA factors) combined with the smokers' low intrinsic motivation. Optimizing the interplay of the extrinsic motivational cues, such as the HCP and SCA factors, would complement the smoker's low intrinsic motivation and thus encourage treatment retention. However, it is necessary to strike a balance between the individual smoker's needs and the availability of organizational support.
authors: Melaka Tengah District Health Office, Melaka, Malaysia. lmei_lin@yahoo.com
authors: Mei Lin
authors: ML
authors: Lee
authors: Mohamed Azmi
authors: MA
authors: Hassali
authors: Asrul Akmal
authors: AA
authors: Shafie
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D001291:Attitude of Health Personnel; D005260:Female; D006282:Health Personnel; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D017060:Patient Satisfaction; D016540:Smoking Cessation; D055815:Young Adult