School of Built Environment and Development Studies, Howard College, University of KwaZulu-Natal, Durban, South Africa.
School of Nursing & Public Health, College of Health Sciences, Howard College, University of KwaZulu-Natal, Durban, South Africa.
Ann Glob Health. 2017 May-Aug;83(3-4):501-508. doi: 10.1016/j.aogh.2017.05.007. Epub 2017 Jun 20.
Drug-resistant tuberculosis (DR-TB) remains a significant cause of morbidity and mortality. The long-term health effects of smoking and the risk of adverse TB outcomes, including increased periods of infectiousness, have been reported among DR-TB patients in South Africa.
This study aimed to identify the barriers to smoking cessation among DR-TB inpatients at a hospital in Durban, South Africa.
A qualitative design using in-depth interviews with a purposive sample of 20 DR-TB inpatients was employed. The sample included 15 men and 5 women aged 18-70 years who self-identified as smokers. Open-ended questions were used to explore barriers militating against smoking cessation among this sample. Data were analyzed with the aid of the software QSR NVivo10.
Personal and structural-level barriers (factors) to smoking cessation were identified. Personal factors included addiction and non-addiction-related barriers. Addiction-related barriers included smoking history, cravings for a cigarette, smoking as part of a daily routine, and failed quit attempts. Non-addiction-related barriers included lack of knowledge about quit strategies, psychosocial stress, lack of the willpower to quit smoking, and the influence of peers. Structural barriers included ineffective health education programs, lack of extramural activities when on admission in hospital leading to a lot of spare time, lack of smoking cessation interventions, and access to cigarettes within and around the hospital environment. Patients expressed interest in smoking cessation and conveyed their frustration at the lack of appropriate support to do so.
The findings reiterate the need for smoking cessation intervention to be incorporated as an integral component of DR-TB management in South Africa. Many patients expressed an interest in pharmacological aids and psychological support to help them to quit smoking. Additionally, offering extramural activities and enforcing smoke-free policies in hospital facilities will help to reduce patients' access to cigarettes while at the hospital.
耐药结核病(DR-TB)仍然是发病率和死亡率的重要原因。在南非的 DR-TB 患者中,已经报道了吸烟的长期健康影响以及包括传染性增加在内的不良结核病结局的风险。
本研究旨在确定德班一家医院住院 DR-TB 患者戒烟的障碍。
采用目的抽样法,对 20 名住院 DR-TB 患者进行了定性设计,并进行了深入访谈。该样本包括 15 名 18-70 岁的男性和 5 名女性,他们自认为是吸烟者。使用开放式问题来探讨该样本中阻碍戒烟的障碍。借助 QSR NVivo10 软件对数据进行了分析。
确定了戒烟的个人和结构层面障碍(因素)。个人因素包括成瘾和非成瘾相关的障碍。成瘾相关的障碍包括吸烟史、对香烟的渴望、将吸烟作为日常生活的一部分,以及戒烟失败的尝试。非成瘾相关的障碍包括缺乏戒烟策略知识、心理社会压力、缺乏戒烟的意志力以及同伴的影响。结构障碍包括健康教育计划无效、入院时缺乏校外活动导致大量空闲时间、缺乏戒烟干预措施以及在医院内外环境中获得香烟。患者对戒烟表示感兴趣,并对缺乏适当的支持表示失望。
这些发现重申了需要将戒烟干预措施纳入南非 DR-TB 管理的综合组成部分。许多患者表示有兴趣使用药物和心理支持来帮助他们戒烟。此外,提供校外活动和在医院设施中实施禁烟政策,将有助于减少患者在住院期间接触香烟的机会。