Exploring the implementation of tobacco cessation services in government healthcare facilities, Maharashtra: a qualitative approach.

BACKGROUND

India is the second-largest consumer of tobacco. Tobacco cessation clinics were introduced in India in 2001 and have been decentralised to the district level through the National Tobacco Control Programme. Research evidence on effective cessation interventions is limited in India.

OBJECTIVES

This paper aims to explore the implementation of tobacco cessation services in the public sector at the district level from a provider perspective.

METHODS

Two Maharashtra districts with a high prevalence of tobacco use were selected. Healthcare providers responsible for tobacco cessation services at the tertiary, secondary and primary levels were purposively selected. An exploratory qualitative study design was employed. Linnan and Steckler’s process evaluation framework guided the design and analysis of the data.

RESULTS

Resources are inadequate to meet the requirements within districts, resulting in a weak ‘reach’ of services to tobacco users. The utilisation of follow-up services is limited except for those with chronic conditions. Among the 5 A’s, ‘Ask’ and ‘Advise’ are common, but the remaining three are used only by select healthcare providers. Data on cessation outcomes are limited, if at all. Healthcare providers reported that cessation outcomes were poor.

CONCLUSIONS

The reach of tobacco cessation services is limited, and there is a need to increase the capacity of primary-level providers with brief key messages. The ‘fear-inducing’ tone is predominant in the ‘Advice’ messages. This needs to be supplemented by ‘Assist’ and ‘Arrange’ approaches. Cessation outcomes should be systematically recorded in health service systems.