Table 2.
Barriers to Treatment Engagement
| Life experiences |
| Stress |
| [I] “could not even think about talking about smoking” [when the] “stress is killing me” [due to not having anything to eat at the house]. |
| “That they keep on denying me the help…I have struggled so much for it [SSI] and this has me very stressed…they denied it three times” [the stress makes patient smoke more] |
| Financial problems |
| One patient was $600.00 behind on her rent, and she had run out of cell phone minutes on her “government” cell phone (she receives 280 minutes per month, but had run out of minutes by the seventh of the month due to many phone calls to and from the hospital for her own medical appointments and those of her grandchildren). |
| Another patient could not participate in telephone quit line counseling because she could not afford minutes on her cell phone. |
| Housing problems |
| “We were paying too much money for a little room … there are a lot of mices (sic), and we call they don’t do nothing, the bathroom is broken, the windows are broken and the cold gets in…[We put] the heat up to 80 degrees but you can’t feel it because it is an old heating system so you spend on gas and heating for nothing because it doesn’t get warm …So I leave the gas alone because I can’t afford to be paying 400 or 500 for gas … so I need to use the electrical heating but the light goes up and this is why I am so stress out smoking…If I had everything fix, I wouldn’t smoke” |
|
Health Beliefs about Nicotine Lack of Trust in Doctors |
| Patient believes drinking a lot of water can help a person to quit smoking: “the water cleanses your system and it cleans the nicotine.” Patient does not believe in using the nicotine patch: “if one wants to quit one should not have any type of nicotine in your system…The doctors won’t tell you but it is true.” |
| Beliefs about quit lines |
| “What is the help line? The help line has nothing to do with people quitting smoking…When people make that decision they do that on their own free will. ‘Don’t buy a pack’ or ‘buy a pack’ ‘don’t buy a carton’ or ‘buy a carton’ … That [counseling] doesn’t stop people from smoking. Be real! … People smoke if they want to smoke…I don’t want to be in no group.” |
| Medical Illness |
| “Because of this illness it’s why smoking is so bad for me, but because of this illness it is why a lot of times I smoke a lot.” |
| Mental health symptoms |
| “When I get anxious in my way to places makes me smoke” |
| Belief that smoking is not causing harm |
| “I know all about it [health effects of smoking]. I don’t care. They checked my lungs and they are all clear…My heart is fine” |
| Family Relationships |
| One patient was concerned about her husband, and felt if he would quit, she would quit. Her daughter also smokes; having several family members who were smoking was a barrier for this patient engaging in treatment. |
| Hospital systems |
| The navigator referred one patient to the hospital smoking cessation group. Major systems problems interfered with the patient being able to attend the group. First, the letter that was sent to the patient had incorrect dates for the group meetings. When the patient tried to attend the group, she was told she could not participate because she had missed the first two sessions. When the navigator contacted the primary care office, the staff was unaware of the smoking cessation program. The navigator was subsequently kept on hold for 20 minutes (prior to hanging up) while waiting to speak with someone knowledgeable about the program. The patient subsequently missed an individual appointment with the smoking cessation counselor. |