Barriers to the provision of smoking cessation services reported by clinicians in underserved communities

Purpose: This qualitative study describes barriers to the provision of smoking cessation services among primary care providers serving medically underserved populations in the state of Georgia. Methods: Eighty-two health care professionals, including clinicians, nurses, administrators, and support staff, participated in 10 focus groups. All sessions were audiotaped and transcribed. A line-by-line analysis of each transcript was conducted. Results: Barriers were grouped into 5 major themes: lack of time, patient unreadiness to change, inadequate patient resources, inadequate provider resources, and inadequate cessation clinical skills. Within this framework, a number of barriers were identified that are of special importance when caring for the underserved. Examples included the tendency of patients to present in "crisis" rather than on an appointment basis; patients' inability to pay out-of-pocket expenses for drug therapy; patients' inability to take time from work for cessation services; limited prescribing authority for clinicians in certain settings; inadequate availability of patient education materials, especially non-English materials; and the need for additional training in smoking cessation for providers. Conclusion: "Safety net" providers encounter barriers to providing smoking cessation services that are similar to barriers faced by clinicians serving more affluent and nonminority populations, but also encounter additional barriers that apply most particularly to the underserved.