Resilience and smoking: the implications for general practitioners and other primary healthcare practitioners

Abstract

BACKGROUND: Smoking cessation counselling is a key component of medical treatment and health promotion activities performed by general practitioners (GPs); however, GPs are often left wondering why their patients continue to smoke in spite of being given information about the damaging health effects and medical treatments. The concept of resilience to smoking is an emerging idea that offers an innovative perspective to smoking cessation. AIMS: To understand why some people continue to smoke in spite of well-known adverse health effects, what and how resilience factors impact on people's smoking, and the role and limitations of the GP in fostering resilience to smoking. METHOD: A qualitative study of 22 oral-history interviews was conducted in Adelaide, South Australia. Interviews were audio-recorded, transcribed and analysed for emergent themes. RESULTS: The main themes of most relevance to GPs are the resilience to health messages, resilience factors associated with smoking abstinence and the common pathways that lead to successful smoking cessation. DISCUSSION: Understanding smoking and resilience can assist the GP to provide more effective and supportive smoking cessation assistance. The GP may assist in the process by fostering the adoption of resilience factors, much of which is already part of routine GP work but may not yet be considered part of a holistic smoking cessation strategy. Through this holistic approach, smoking cessation is likely to be just one of many physical and social benefits, and avoids victim blaming. Broad system change to increase the levels of resilience within individuals and communities may then mean that smokers can stop more easily with brief interventions. Such changes are beyond the limits of a single GP, but provide opportunities to lobby government for future public health programmes aimed at promoting both the internal traits and external resources that are required for resilience building.