Adherence and Compliance With Smoking Cessation in Primary Health Care

Background Smoking remains a major contributor to preventable disease and mortality. Although smoking cessation programs are widely implemented, quit rates remain low and relapse is common. Pharmacological therapies such as nicotine replacement therapy, varenicline, and bupropion can improve quit rates, but their real-world effectiveness is often limited by poor adherence. This study aimed to evaluate adherence to smoking cessation clinic follow-up, adherence to prescribed pharmacotherapy, smoking cessation outcomes, and associations between selected demographic and treatment-related factors and smoking cessation success. Methodology A cross-sectional study was conducted at four primary care smoking cessation clinics affiliated with King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. All smokers who attended these clinics were eligible, with pregnant women excluded. Using OpenEpi, a random sample of 344 participants was selected from 1,860 patients. Data were collected from medical records and a validated telephone-administered Arabic questionnaire. Smoking cessation outcomes, pharmacotherapy adherence, and reasons for non-adherence were assessed by participant self-report during telephone interviews. Statistical analysis was performed using SPSS version 26, applying descriptive statistics and chi-square tests with significance set at p-values <0.05. Results A total of 344 patients were analyzed, with a mean age of 42 years (SD = ±12); nearly half (49.1%) were aged 40-59 years, and 98.5% were male. Most participants attended only one visit (47.1%). Pharmacologic interventions were prescribed to 44.8% of patients, primarily varenicline (74.7%). The overall smoking cessation success rate was 32.6%. Among participants who reported discontinuation of follow-up visits, lack of motivation was the most commonly reported reason (64.1%). Among participants who provided a reason for non-adherence to pharmacotherapy, medication side effects were the leading reason (24.1%), with nausea being the most frequently reported side effect (9.9%). Younger participants (10-17 years) achieved the highest quit rate (66.7%, p = 0.009); however, this finding should be interpreted cautiously because the age group included only three participants. Clinic visit frequency was not associated with smoking cessation success (p = 0.117). Patients prescribed pharmacotherapy had numerically higher quit rates than those who did not receive pharmacotherapy (35.1% vs. 30.5%); however, this difference was not statistically significant (p = 0.372). Adherence to prescribed medication was significantly associated with higher quit rates (43.4% vs. 14.3%, p = 0.001). Conclusions The clinic achieved a quit rate comparable to international standards. Adherence to prescribed pharmacotherapy was associated with higher smoking cessation rates, whereas receipt of pharmacotherapy alone was not significantly associated with smoking cessation success. Low motivation and medication side effects were commonly reported barriers and may represent important targets for interventions aimed at improving engagement and smoking cessation outcomes.