title: Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians.
abstract: BACKGROUND
  Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs).
  
  
  OBJECTIVE
  To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients.
  
  
  METHODS
  A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced.
  
  
  RESULTS
  Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients' inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care.
  
  
  CONCLUSIONS
  Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption.
authors.affiliation: Family Medicine Solo Practice, Bucharest, Romania.
authors.forename: Catalina
authors.initials: C
authors.lastname: Panaitescu
authors.affiliation: Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK.
authors.forename: Mandy A
authors.initials: MA
authors.lastname: Moffat
authors.affiliation: International Primary Care Respiratory Group, London, UK.
authors.forename: Siân
authors.initials: S
authors.lastname: Williams
authors.affiliation: Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.affiliation: Psychotherapy Solo Practice, Bucharest, Romania.
authors.forename: Melinda
authors.initials: M
authors.lastname: Boros
authors.affiliation: Family Medicine Solo Practice, Bucharest, Romania.
authors.forename: Cristian Sever
authors.initials: CS
authors.lastname: Oana
authors.affiliation: Family Medicine Solo Practice, Bucharest, Romania.
authors.forename: Sandra
authors.initials: S
authors.lastname: Alexiu
authors.affiliation: 1] Agia Barbara Health Care Centre, Crete, Greece [2] Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Tsiligianni
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012383:Romania; D016540:Smoking Cessation