What Explains Provider-Delivered Smoking Cessation Counseling to Rural Medicaid Patients?

Tobacco use among the Medicaid population is almost double that in the general population. Health care providers are key in promoting smoking cessation. This study explored the influence of providers' attitudes, normative beliefs, and perceived behavior control on provider-delivered brief cessation counseling to rural Medicaid-enrolled smokers. Interviews were conducted with health care providers who regularly see Medicaid patients. The interview questions addressed three constructs of the Theory of Planned Behavior: 1) attitudes (towards Medicaid-enrolled smokers and the behavior of cessation counseling); 2) normative beliefs (perceptions of Medicaid administrators' interests in adopting a cessation program); and 3) perceived behavioral control (perceived ability to deliver cessation counseling). All providers delivered some cessation counseling to their patients despite not receiving reimbursement for counseling. Overall, attitudes appeared to be a major determinant of providers' delivery of cessation counseling. Providers perceived that a large proportion of smokers had no desire to quit, and they recognized that advising smokers to quit may be ineffective among smokers not ready to quit. However, they did not indicate that they were following the Clinical Practice Guideline Treating Tobacco Use and Dependence recommendations to encourage smokers to move towards getting ready to quit smoking by providing motivational interventions. Normative beliefs and perceived behavioral control did not appear to influence provider behavior. Training for providers on how to conduct brief motivational interventions to unmotivated smokers may be beneficial to promote compliance with the Guideline.