Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis

© 2019 Society for the Study of Addiction Aim: To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). Design: Cross-sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. Setting and participants: Survey respondents (n=127 countries) who completed an open-ended question on the 26-item survey. Measurements: The open-ended question asked the following: ‘In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country?’. We conducted thematic analysis of the responses. Findings: The most frequently reported barriers included a lack of health-care system infrastructure (n=86) (e.g. treatment not integrated into primary care, lack of health-care worker training), low political priority (n=66) and lack of funding (n=51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n=11), policymakers’ lack of awareness about the effectiveness and affordability of TDT (n=5), public norms supporting tobacco use (n=11), a lack of health-care leadership and expertise in the area of TDT (n=6) and a lack of grassroots and multi-sector networks supporting policy implementation (n=8). The analysis captured patterns of co-occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health-care infrastructure and capacity to implement Article 14. Conclusion: Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a health-care system infrastructure, low political priority and lack of funding