MATERIALS AND METHODS: Six focus groups were conducted using a semi-structured interview guide on 40 informants (employed multiethnic survivors). Survivors were stratified into three groups for successfully RTW, and another three groups of survivors who were unable to return to work. Each of the three groups was ethnically homogeneous. Thematic analysis using a constant comparative approach was aided by in vivo software.
RESULTS: Participants shared numerous barriers and facilitators which directly or interactively affect RTW. Key barriers were physical-psychological after-effects of treatment, fear of potential environment hazards, high physical job demand, intrusive negative thoughts and overprotective family. Key facilitators were social support, employer support, and regard for financial independence. Across ethnic groups, the main facilitators were financial-independence (for Chinese), and socialisation opportunity (for Malay). A key barrier was after-effects of treatment, expressed across all ethnic groups.
CONCLUSIONS: Numerous barriers were identified in the non-RTW survivors. Health professionals and especially occupational therapists should be consulted to assist the increasing survivors by providing occupational rehabilitation to enhance RTW amongst employed survivors. Future research to identify prognostic factors can guide clinical efforts to restore cancer survivors to their desired level/type of occupational functioning for productivity and wellbeing.
DESIGN: Individual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method.
PARTICIPANTS AND SETTING: Fifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included.
RESULTS: A five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception: perception among smokers that ability to quit was solely based on one's ability to achieve mind control, and perception that stopping smoking will harm the body and (5) Failed assisted smoking cessation: smoking cessation services were not felt to be user-friendly and were poorly understood. The themes were organised into five concentric circles based on time frame: those actionable in the short term (themes 1 and 2) and the long term (themes 3, 4, 5).
CONCLUSIONS: Five themes of specific beliefs and practices prevented smokers from quitting. Clinicians need to work on these barriers, which can be guided by the recommended time frames to help patients to succeed in smoking cessation.