BACKGROUND : Evidence suggests that healthcare providers (HCPs) in South Africa do not consistently offer tobacco
dependence treatment (TDT) during clinical consultations. In order to understand and explain this behaviour in a
South African context, we conducted a qualitative exploration of HCPs’ experiences, perceptions and behaviours
METHODS : Individual qualitative interviews were conducted with physicians and nurses who were purposively
selected. Themes were identified from interview transcripts using content analysis. Findings were triangulated and
peer-reviewed, and were also verified by the participants.
RESULTS : Fifteen physicians and four nurses were interviewed, none of whom used tobacco. These participants
perceived TDT as an important task, but could not consistently implement it during clinical consultations due to health
systems constraints (time-constraints because of patient-overload, the unavailability of cessation medications and a lack
of support for referrals), misperceptions and misconceptions (negative outcome expectations about the effectiveness
and feasibility of TDT), socio-cultural barriers (counselling older persons was perceived as challenging) and personal
limitations (perceived low self-efficacy, poor knowledge and skills on implementing any evidence-based TDT
framework). Patients are therefore selectively screened based on clinical relevance and offered only prescriptive
brief advice. Participants recommended several systems changes, including academic detailing of tobacco status,
training HCPs and incorporating tobacco cessation medications in the Essential Drug List.
CONCLUSION : The reported selective screening and limited TDT interventions offered by HCPs are related to interactions
between health systems constraints, personal limitations, and misperceptions and misconceptions about the effectiveness
and feasibility of TDT during clinical consultation. Implementing the recommended systems changes has the potential to
improve the implementation of TDT in South African primary health care (PHC).