Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany

Background: General practitioners (GPs) can contribute substantially to the promotion of smoking cessation in the general population. However, engagement of GPs in helping their patients to quit remains very limited in many countries, including Germany. Therefore, new strategies to foster implementation of evidence-based methods in smoking cessation assistance have to be identified, and data for current practice of and barriers against smoking cessation promotion in general practice are needed. Methods: A cross-sectional survey among all 657 general practitioners practising in the Rhein-Neckar Region of Germany, was conducted in spring 2002 using a postal questionnaire (response rate 48%). Results: The majority (54%) of GPs reported having treated less than 10 patients for smoking cessation (by any means including mere advice to quit) within the last three months, 23% of GPs never received any education or training in smoking cessation promotion, and only one third of GPs rated their training as adequate. The factor most strongly associated with low activity in smoking cessation promotion (defined as having treated less than 10 patients within the last three months) was perceived lack of training (odds ratio 2.70, 95% confidence interval 1.68 - 4.32), followed by perceived lack of demonstration material (2.10, 1.31 - 3.39) and perceived lack of time (1.65, 1.02 - 2,66). Furthermore, there was a clear dose-response relationship between the time spent on training and the activity in smoking cessation promotion. Conclusion: Adequate training may be a key factor to enhance engagement of general practitioners in the promotion of smoking cessation.