A COM-B analysis of facilitators of and barriers to smoking cessation among Chinese smokers——a qualitative study

Introduction: Despite the Chinese government’s efforts, smoking prevalence remains high and motivation to quit stays at a low level in China. However, few studies have examined the perceptions, behaviors, and attitudes related to quitting smoking specifically, especially in a theory-based deductive manner. This study deployed the COM-B model as a framework to explore smoking cessation among Chinese smokers. Methods: : Forty 30-minute individual in-depth interviews were conducted with a semi-structured moderator guide. Participants (N = 40) were current smokers and ex-smokers aged 18 years or older. A directed content analysis approach was utilized for examining interview data. Results: : Smokers’ motivation to stop smoking was influenced by their beliefs about the health consequence. Regarding smoking as a personal choice and habit and overemphasis on willpower both impeded smokers’ motivation to quit. The positive social climate change improved smokers’ opportunity for cessation, but the insufficient and underused smoking cessation services and family support were detrimental to their opportunity. Incapability to handle invitations from others and deal with negativity and inadequate knowledge about smoking and cessation represented smokers’ insufficient capability to quit smoking. Conclusions: : The barriers impeding Chinese smokers’ quitting attempts as well as the facilitators promoting their cessation were determined from three perspectives: motivation, opportunity, and capability. Publicity and education campaigns should target smokers’ misconception that smoking is a symbol of personal freedom, correct their misplaced overemphasis on willpower, promote the existing smoking cessation services wildly, and most importantly shape the social norm into a more anti-smoking way. Using real story to demonstrate the health consequences of smoking, disseminating information about smoking cessation services in the maternity center, enriching the existing smoking cessation services by embracing mobile health, and empowering family support may better facilitate smoking cessation in China. Implications: The present study has both practical and theoretical significance. These barriers and facilitators presented in this study could inform future smoking cessation programs. Besides, the deployment of the COM-B model in the analysis of smoking cessation could boost its use in other fields in China.