Motivators and barriers for smoking cessation in people with multiple sclerosis: a qualitative study to inform the design of a tailored intervention

Background: Tobacco smoking is a relevant determinant of multiple sclerosis (MS) onset, and smokers have increased risk for faster progression of MS compared to non-smokers. While the smoking prevalence is high in Germany, no smoking cessation programs have been developed specifically in MS populations to date, and only little is known about the motivators and barriers influencing smoking cessation in people with MS (pwMS) in Germany. This study aims to identify these factors to inform the design of a tailored smoking cessation intervention.

Methods: As part of a larger program of work, we conducted semi-structured interviews in people with MS (pwMS) to explore their needs, motivators and barriers regarding smoking cessation. We recruited via MS-websites and the email-newsletter of our institution at the University Medical Centre Hamburg-Eppendorf. Participants were eligible if they had a self-reported MS-diagnosis and currently smoked or quit smoking within the last two years but after their MS-diagnosis. Interviews were conducted online and via telephone during May and June 2023. Data were analysed using thematic analysis based on a realistic approach.

Results: Eight women and seven men participated in our interviews. Eleven were current, four were former smokers. Median time since diagnosis was 4 years (range: 1-26). Interviews identified MS-diagnosis, concerns about general health, and social factors as relevant motivators to stop smoking. Furthermore, worries about negative consequences when quitting (e.g. fear of missing out on social interactions or weight gain) were identified as a great barrier to smoking cessation. Knowledge about the connection between MS and smoking, and satisfaction with communication with MS clinicians were low. PwMS expressed a need for better conversations with neurologists and expert-led smoking cessation interventions. Additionally, we found that the wish for peer-exchange and the willingness to participate in smoking cessation programs was high.

Conclusion: Our results confirm findings of previous studies from other countries, identifying lack of knowledge, unsatisfactory communication with MS clinicians, and worries about negative consequences when quitting as barriers, and the MS-diagnosis as a motivator for smoking cessation. In a next step, we will use our findings for the development of an MS-specific online smoking cessation program.