Table 3 Categorization of themes, frequency of quotes per subtheme, and sample quotes of experts’ opinions on the barriers to help people quit smoking cigarettes

Tobacco treatment program characteristics

Structural components

(defined as high costs, the time commitment, impersonal offer)

8

High costs can be an access barrier to the intervention. (Participant #3 and #8)

To my experience, over a longer period of time, only few participants attend the sessions consistently. The time commitment can complicate the success of the intervention. (Participant #1)

It is complicated when patients are tackling several projects at the same time, of which smoking cessation is only one. (Participant #4)

Phone offered programs can be too impersonal (Participant #10)

Participant characteristics

Cognitive barriers to change (defined as a fear of failure, fear of loss, fear of negative emotional consequences, dysfunctional attitudes and beliefs, lack of information)

27

There is the fear of experiencing a permanent lack. (Participant #5)

Participants can fear remaining unsuccessful after several attempts (Participant #8)

Emotional factor can lead to not even trying to quit smoking (Participant #1)

Participants believe that nicotine satisfies various needs (Participant #7)

Participants frequently compare smoking to alcohol in road traffic…in this comparison the risk of tobacco use seems secondary (Participant #2)

Comorbid condition

7

There are difficulties in smoking cessation…with depression…nicotine also has an antidepressant effect and can work as a psychological anchor. (Participant #1)

Additional diagnoses in the psychiatric area complicate the success of the intervention…if an additional diagnosis is present, I first advise for the treatment of this diagnosis, then proceed to smoking cessation. (Participant #3)

Social environment

External pressure, including frequent exposure to people who smoke

15

External convincing to quit smoking has a low probability of success. (Participant #1)

Participants’ mindset needs to change from ‘I shouldn’t smoke’ to ‘I don’t need to smoke’, thus leaving behind perceived external pressure. External advice is problematic. (Participant #6)