Implementing a smoking cessation service in routine and manual workplaces: A qualitative service evaluation

Abstract

Objectives Routine and manual workers have higher smoking rates than those in professional occupations, contributing to health inequalities. Workplace cessation interventions may increase long-term abstinence in this group, but employee uptake is low, and managers often oppose onsite delivery. We aimed to understand the barriers and facilitators to implementation and employee uptake of a workplace smoking cessation service from the perspective of cessation advisors, workplace managers, and service coordinators. The service was a free 12-16-week programme of weekly behavioural support plus nicotine replacement therapy, medication, or an e-cigarette. Study design Qualitative service evaluation. Methods One cessation advisor, one workplace manager, and two service coordinators (one from the council and one from the service provider) participated in semi-structured interviews. Data were descriptively analysed against the four constructs of Normalisation Process Theory. Results Coordinators reported misunderstandings about the scope of the service and which workplaces were eligible, alongside employer concerns about perceived administrative and financial burdens (Coherence). Concise communication and council involvement helped navigate organisational gatekeepers, although outreach was constrained by limited dedicated capacity (Cognitive Participation). Workplace factors, including lack of private space and shift-work patterns, reduced employee uptake (Collective Action). Participants also highlighted threats to long-term sustainability, including limited anonymised feedback to managers on uptake and cessation outcomes and the need for repeated managerial approvals for onsite delivery (Reflexive Monitoring). Conclusions Implementation of smoking cessation services within routine and manual workplaces may hinge on improving communication between those who commission and deliver services and the workplaces they seek to support.