Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers.
OBJECTIVE
When tobacco smokers quit, between half and two-thirds quit unassisted: that is, they do not consult their general practitioner (GP), use pharmacotherapy (nicotine-replacement therapy, bupropion or varenicline), or phone a quitline. We sought to understand why smokers quit unassisted.


METHODS
Qualitative grounded theory study (in-depth interviews, theoretical sampling, concurrent data collection and data analysis).


METHODS
21 Australian adult ex-smokers (aged 28-68 years; 9 males and 12 females) who quit unassisted within the past 6 months to 2 years. 12 participants had previous experience of using assistance to quit; 9 had never previously used assistance.


METHODS
Community, Australia.


RESULTS
Along with previously identified barriers to use of cessation assistance (cost, access, lack of awareness or knowledge of assistance, including misperceptions about effectiveness or safety), our study produced new explanations of why smokers quit unassisted: (1) they prioritise lay knowledge gained directly from personal experiences and indirectly from others over professional or theoretical knowledge; (2) their evaluation of the costs and benefits of quitting unassisted versus those of using assistance favours quitting unassisted; (3) they believe quitting is their personal responsibility; and (4) they perceive quitting unassisted to be the 'right' or 'better' choice in terms of how this relates to their own self-identity or self-image. Deep-rooted personal and societal values such as independence, strength, autonomy and self-control appear to be influencing smokers' beliefs and decisions about quitting.


CONCLUSIONS
The reasons for smokers' rejection of the conventional medical model for smoking cessation are complex and go beyond modifiable or correctable problems relating to misperceptions or treatment barriers. These findings suggest that GPs could recognise and respect smokers' reasons for rejecting assistance, validate and approve their choices, and modify brief interventions to support their preference for quitting unassisted, where preferred. Further research and translation may assist in developing such strategies for use in practice.
Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Andrea L
AL
Smith
Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Stacy M
SM
Carter
School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Simon
S
Chapman
School of Public Health, University of Sydney, Sydney, New South Wales, Australia Cancer Screening and Prevention, Cancer Institute NSW, Eveleigh, New South Wales, Australia.
Sally M
SM
Dunlop
Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Becky
B
Freeman
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D016642:Bupropion; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D018722:Nicotinic Agonists; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*
D018722:Nicotinic Agonists; D016642:Bupropion
PREVENTIVE MEDICINE; PRIMARY CARE; PUBLIC HEALTH; QUALITATIVE RESEARCH