BACKGROUND: Primary healthcare (PHC) facilities play a crucial role in offering tobacco cessation (TC) support, as many patients struggle to sustain their quit attempts without guidance from healthcare professionals. This study explores barriers to enhancing cessation efforts and integrating effective counseling practices within PHC services in Bangladesh.
METHODS: A mixed-methods study was conducted. A survey was done to assess knowledge and practice regarding TC counseling, 328 nurses trained in NCD care delivery and working at the PHC level were selected from 55 randomly chosen sub-districts across Bangladesh. Ten key informant interviews with policymakers and facility managers were conducted to explore barriers to integrating TC counseling into PHC services. Direct observation of 46 nurses at NCD corners during service delivery was performed to assess actual TC counseling practices. Descriptive and thematic analyses were performed to interpret the findings. Adequate knowledge and favorable practice were defined as achieving a mean score of ≥60%.
RESULTS: Among 328 nurses, 73.8% had in-service training on TC counseling, and 68.8% were trained in 5A cessation approach. While 80.8% of nurses reported counseling patients, only 11.9% demonstrated adequate TC knowledge, and 20.7% adhered to 5A approach. Key informants identified several barriers to effective TC counseling, including limited time, inadequate training, insufficient staff, uncooperative patients, absence of national guidelines, and perceptions that TC was outside nurses' responsibilities. Direct observations of practice at NCD corners revealed among 555 new patients, 12.3% were asked about tobacco use and advised to quit by the nurses, while just 0.5% were assessed and assisted. Follow-up support was offered to one patient.
CONCLUSIONS: The study highlights barriers to effective TC at multiple levels within patient, provider, organizational and national levels. These findings highlight the urgent need for tailored interventions, including training, policy development, and integration of TC into routine PHC services, to enhance cessation outcomes in Bangladesh.