AIM To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). DESIGN Cross-sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. SETTING AND PARTICIPANTS Survey respondents (n=127 countries) who completed an open-ended question on the 26-item survey. MEASUREMENTS The open-ended question asked the following: In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country? We conducted thematic analysis of the responses. FINDINGS The most frequently reported barriers included a lack of health care system infrastructure (n=86) (e.g., treatment not integrated into primary care, lack of health care worker training), low political priority (n=66) and lack of funding (n=51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n=11), policymakers' lack of awareness about the effectiveness and affordability of TDT (n=5), public norms supporting tobacco use (n=11), a lack of health care leadership and expertise in the area of TDT (n=6) and a lack of grassroots and multisector networks supporting policy implementation (n=8). The analysis captured patterns of co-occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health care infrastructure and capacity to implement Article 14. CONCLUSION Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a healthcare system infrastructure, low political priority and lack of funding.

中文翻译：

---

实施世卫组织《烟草控制框架公约》戒烟治疗指南面临的挑战：定性分析

目的 确定实施世界卫生组织 (WHO) 烟草控制框架公约 (FCTC) 第 14 条烟草依赖治疗 (TDT) 指南的障碍。设计 2014 年 12 月至 2015 年 7 月进行的横断面调查，以评估第 14 条建议的实施情况。设置和参与者 完成 26 项调查的开放式问题的调查受访者（n=127 个国家/地区）。测量 开放式问题提出以下问题：在您看来，在贵国开展进一步烟草依赖治疗的主要障碍或挑战是什么？我们对答复进行了专题分析。结果 最常报告的障碍包括缺乏卫生保健系统基础设施（n=86）（例如，治疗未整合到初级保健中，缺乏卫生保健工作者培训）、低政治优先级（n=66）和缺乏资金（n=51）。缺乏执行第 14 条的战略计划和国家指导方针成为政治优先事项的分主题。也被描述为障碍的还有提供者对提供 TDT 的消极态度（n=11）、政策制定者对 TDT 的有效性和可负担性缺乏认识（n=5）、支持烟草使用的公共规范（n=11）、缺乏TDT 领域的卫生保健领导力和专业知识（n=6），以及缺乏支持政策实施的基层和多部门网络（n=8）。分析捕捉到了共同出现的主题模式，这些模式将政治支持水平低与缺乏发展医疗保健基础设施和执行第 14 条的能力所需的资金联系起来。