Background:
Teachable moments (TM) have been advocated for endorsing health behavior change in a variety of settings. While primary healthcare settings have been the most potential venue for providing smoking cessation, physicians miss many TM to discuss smoking with their patients at every medical visit. The study aimed to reveal what influences primary healthcare physicians' (PHPs) decision to utilize TMs to facilitate smoking cessation counselling with patients.

Methods:
The study team implemented a qualitative research through focus group discussions with PHPs using a semi-structured guide. Purposive sampling was used to recruit participants (n=23) from two Armenian cities (the capital city Yerevan and the second largest city Gyumri). We transcribed the collected data and analyzed by the directed content analysis technique.

Results:
The study results illustrated several misconceptions that hamper PHPs to utilize TM for providing smoking cessation counselling to their patients. Majority of PHPs reported that they preferred discussing smoking only with those patients who expressed explicit concern about smoking, as they were afraid of harming physician-patient relationship. PHPs' believed that asking patients about their smoking status could be intrusive and lead to conflict situations. Some of PHPs were considering smoking as a culturally sensitive issue and preferred checking smoking status of men rather than women. Physicians also tend to miss the opportunity to discuss smoking with special patient subgroups (elderly patients, patients with other co-morbidities) because of the misbelief that smoking "already harmed" them and their health problems take precedence over smoking cessation counseling.

Conclusions:
Physicians missed opportunities to employ TMs for smoking cessation counseling with patients. Physicians appear to prioritize smoking cessation counseling based on patients' socio-demographic characteristic (age, gender), as well as diagnosis at the time of the visit. Specific interventions should be implemented to instruct physicians' to capitalize on TM and discuss smoking cessation during routine consultations with all patients.