Patient perspectives to inform the implementation of tobacco use treatment in Lebanon's safety net primary care system: a qualitative study.

objectiveTo inform the adaptation of an existing tobacco use treatment (TUT) programme into a contextually appropriate service for Lebanon's safety-net primary care system.

designIn-person focus group discussions with an in-depth thematic analysis.

settingTwo primary healthcare centres in Beirut, Lebanon

participants61 individuals who smoked cigarettes (n=36) and waterpipe (n=25).

resultsThe 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.

conclusionsTobacco 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.