Misconceptions about smoking in patients with type 2 diabetes mellitus: a qualitative analysis

Aims and objectives: To investigate the smoking behaviours, perceptions about quitting smoking and factors associated with intention to quit in patients with type 2 diabetes mellitus.

Background: Smoking causes type 2 diabetes mellitus. There has been limited research on the needs and concerns of smokers with type 2 diabetes mellitus about quitting smoking.

Design: The study used a qualitative design.

Methods: Patients diagnosed with type 2 diabetes mellitus who had a history of smoking were recruited at the outpatient diabetic clinics of two major local hospitals in Hong Kong for a semi-structured interview (n = 42), guided by the theory of planned behaviour.

Results: At data saturation, 22 current smokers and 20 ex-smokers with type 2 diabetes mellitus were recruited. The current smokers reported they had not quit smoking because of satisfaction with present health status, and misconceptions about the association between diabetes and smoking, and the perceived hazards of quitting. In contrast, ex-smokers had a positive opinion about quitting smoking, accepted advice about quitting from health professionals and received more family support than current smokers. Psychological addiction and weight gain after cessation made quitting challenging.

Conclusions: Satisfaction with health status, inadequate knowledge about the relationship between type 2 diabetes mellitus and smoking, and misconceptions about quitting smoking resulted in negative attitudes toward quitting by type 2 diabetes mellitus smokers. Smoking peers, psychological addiction and post-cessation weight gain hindered the quitting process.

Relevance to clinical practice: Education on the causal link between smoking, type 2 diabetes mellitus and its complications is important to raise health awareness and counter misconceptions about quitting smoking. Behavioural counselling with weight control strategies should be part of a comprehensive smoking cessation intervention for type 2 diabetes mellitus smokers.