BACKGROUND: Second-hand smoke (SHS) exposure is among the top three global risk factors for disease burden, along with high blood pressure and household air pollution from solid fuels. However, smoke-free laws are not applicable in domestic spaces, and SHS exposure persists in homes. Therefore, the objective of the study is to understand the barriers, enablers, and impact of a smoke-free home intervention on household dynamics, health, and well-being from the perspectives of smokers, family members, and community health workers (CHWs).
METHODS: This descriptive qualitative study, part of a community intervention in Kochi slums, involved 15 clusters, each in intervention and control arms (657 smokers), using CHWs to promote indoor smoking cessation through health education and community engagement, aiming to assess the intervention's effectiveness. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted using semi-structured guides among smokers (who quit/reduced indoor smoking), spouses, CHWs, and children. FGDs and interviews were audio-recorded, transcribed verbatim, and translated into English and thematically analysed using MAXQDA software.
RESULTS: A total of 11 FGDs and 14 interviews revealed key themes about smoking behaviour and quitting challenges. Participants started smoking due to peer influence and struggled to quit indoors, despite reducing smoking over time. Key motivators for quitting included health concerns, family support, and CHW encouragement, while cravings, stress, and social pressure were barriers. Health improvements and financial savings were significant benefits. Family pressure, particularly from children, played a vital role in motivating cessation. Underpinning this were the CHW interventions. Despite positive changes, complete cessation remained difficult, with relapse triggered by environmental and personal factors.
CONCLUSIONS: The smoke-free home intervention successfully reduced indoor smoking and SHS exposure in Kochi's slums, driven by health concerns, family support, and CHW involvement. Challenges such as relapse and social pressures indicate the need for sustained efforts to achieve complete cessation.