BMJ open · 2026
Patient perspectives to inform the implementation of tobacco use treatment in Lebanon's safety net primary care system: a qualitative study.
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Tohme Sara, Bteddini Dima, Romani Maya, Kabakian-Khasholian Tamar, El Kadi Lama, Abla Ruba, El Ashkar Catherine, Montague Magda, Theis Ryan, Khaywa Jihan, Osman Mona H, Ward Kenneth, Shelley Donna R, Nakkash Rima, Salloum Ramzi G, LeLaurin Jennifer H
Аннотация
OBJECTIVE: To inform the adaptation of an existing tobacco use treatment (TUT) programme into a contextually appropriate service for Lebanon's safety-net primary care system.
DESIGN: In-person focus group discussions with an in-depth thematic analysis.
SETTING: Two primary healthcare centres in Beirut, Lebanon PARTICIPANTS: 61 individuals who smoked cigarettes (n=36) and waterpipe (n=25).
RESULTS: The analysis revealed four primary themes: 1) smoking as a coping mechanism for national crisis, 2) lack of perceived fit of the programme with the Lebanese context, 3) differing perceptions of harm and addiction by tobacco product, 4) perceived effectiveness of programme components. Participants reported that smoking helped them cope with stress resulting from the national crisis and felt that patient education material did not reflect local norms around tobacco use. Participants' views on the relative harm and addictiveness of cigarettes and waterpipe were often discussed in the context of differing use patterns. Addressing mental health, using competent and non-judgmental counsellors, and sharing real-life success stories were recommended to improve engagement in TUT.
CONCLUSIONS: Tobacco is embedded within the Lebanese social and cultural life. Our findings inform implementation efforts by identifying contextual needs specific to the Lebanese population that smokes. Tailoring TUTs can increase acceptability, effectiveness and sustainability of smoking cessation efforts in Lebanon and similar low-resource contexts.
DESIGN: In-person focus group discussions with an in-depth thematic analysis.
SETTING: Two primary healthcare centres in Beirut, Lebanon PARTICIPANTS: 61 individuals who smoked cigarettes (n=36) and waterpipe (n=25).
RESULTS: The analysis revealed four primary themes: 1) smoking as a coping mechanism for national crisis, 2) lack of perceived fit of the programme with the Lebanese context, 3) differing perceptions of harm and addiction by tobacco product, 4) perceived effectiveness of programme components. Participants reported that smoking helped them cope with stress resulting from the national crisis and felt that patient education material did not reflect local norms around tobacco use. Participants' views on the relative harm and addictiveness of cigarettes and waterpipe were often discussed in the context of differing use patterns. Addressing mental health, using competent and non-judgmental counsellors, and sharing real-life success stories were recommended to improve engagement in TUT.
CONCLUSIONS: Tobacco is embedded within the Lebanese social and cultural life. Our findings inform implementation efforts by identifying contextual needs specific to the Lebanese population that smokes. Tailoring TUTs can increase acceptability, effectiveness and sustainability of smoking cessation efforts in Lebanon and similar low-resource contexts.