How might the provision of smoking cessation services be adapted to improve uptake and success for people in low socioeconomic groups: A qualitative component of the UK PROCESS study

Significance Smoking is a key driver of health inequalities and is an important factor in cancer incidence across the UK. Stop Smoking Services (SSS) offer a combination of behavioural and pharmacological support to help people quit smoking. Individuals who use SSS are three times more likely to successfully quit than those who try to quit unaided but uptake of services is low, particularly amongst low socioeconomic (LSE) groups. Investigation of how SSS can be more engaging and accessible for this group is essential. Methods The aim of this UK-wide mixed-methods study is to understand the appeal, acceptability and accessibility of SSS for people in LSE groups, and the barriers and facilitators to uptake. The qualitative component of this study is comprised of two work packages: qualitative interviews with SSS providers (n=22) and with people from LSE backgrounds who are potential or previous service users (n=115). Topic guides were informed by the COM-B Model (Capability, Opportunity, Motivation – Behaviour). Interviews were audio recorded, transcribed, and coded thematically supported by NVivo. The findings were mapped to theoretical domains of the COM-B Model in order to guide SSS interventions and policy decision-making. Results While analysis of interviews with SSS users is ongoing, preliminary findings from interviews with SSS providers suggest that facilitators to LSE groups accessing SSS included proximity of services, flexibility of service delivery, and free NRT provision. Barriers included waiting lists, staffing short- ages, lack of service visibility and advertisement, and perceived stigma and lifestyle factors amongst LSE groups. The use of digital technology in service provision was identified as both a barrier and facilitator. Recommendations for service enhancement included improved visibility and awareness of SSS (Capability), enhanced community links to embed services or support referral pathways (Opportunity) and person-centred approaches to service delivery (Motivation). Conclusion Early findings from this study provide essential evidence on practical solutions for adapting SSS delivery, increasing uptake and improving outcomes, thereby reducing the overall health pressure and inequalities among individuals who smoke. The results of this study will be discussed in a roundtable event with the stakeholders (health/smoking agencies, service users, service providers from the UK) to support recommendation development.