Table 3 Summary of perceived facilitators and barriers

Intervention characteristics

Facilitators: Intervention should be simple, accessible, and adaptable.

Outer setting

Facilitators: policies and incentives (tobacco control measures, anti-smoking social norms, funding for public health and cessation clinics), systems-level interventions allowing easy referral to cessation programs or community-based support.

Inner setting

Barriers: time and resource constraints, lack of access to free cessation medications and follow-up appointments, incompatibility with and lower priority of smoking cessation compared to existing clinical demands, lack of knowledge and training around guideline changes.

Patient/physician characteristics

Barriers: smokers with greatest risk of cardiovascular disease are less likely to take up health check invitations, some patient characteristics are associated with worse smoking outcome measures, smokers’ lack of awareness of, and negative perceptions about, the effectiveness of cessation medications; physicians having doubts about the effectiveness and safety of cessation interventions and not feeling competent to deliver cessation counselling.

Implementation process

Facilitators: multifaceted approaches to intervention implementation (which include audit and feedback)

Barriers during the execution of intervention implementation delivery: wording/coding of targets not optimally targeting the desired clinical behaviours/outcome measures, focussing on the ‘risk factor identification’ and not the ‘intervention’ aspects of cessation treatment, lack of sustained advertising of cessation support, insufficient messaging to patients trying to quit smoking about the cessation support options that are available