Free cessation aids and enhanced support for smoking cessation in disadvantaged smokers: a qualitative study of patient and provider insights

AIM: To explore facilitators and barriers to smoking cessation among smokers experiencing socioeconomic disadvantage, from the perspectives of patients and healthcare providers (HP) participating in the STOP randomized controlled trial (STOP-RCT). BACKGROUND: Smoking remains disproportionately prevalent among socioeconomically disadvantaged individuals, contributing to significant health disparities. The STOP-RCT evaluates a preference-based smoking cessation intervention offering free nicotine replacement therapy (NRT) and e-cigarettes to disadvantaged smokers. METHODS: A qualitative study was conducted involving semi-structured interviews with 14 participants and 5 HP from the STOP-RCT. Data collection explored participants' smoking cessation experiences, perceptions of the intervention, the quitting process, and the factors that influence cessation. Thematic analysis was used to analyse the transcribed data. Themes were categorized into structural and individual factors, refined iteratively, and supported by illustrative quotes. FINDINGS: Four key facilitators were identified: (1) longer consultations enabling tailored support; (2) regular follow-up promoting patient engagement; (3) immediate and free access to NRT and carbon monoxide (CO) monitoring, reducing financial and practical barriers while providing feedback; and (4) shared decision-making, strengthening trust and improving the fit of support. These findings highlight the importance of addressing both treatment approach (contextual) and interpersonal factors for this population. Considering these elements may help adapt cessation programmes to the specific difficulties and needs of patients with low socioeconomic position, thereby reinforcing treatment adherence and improving effectiveness.