Beliefs, knowledge and recommendations of general practitioners in the United Kingdom about e-cigarettes as smoking cessation aids: a mixed-methods study

Many organisations in the UK are encouraging GPs and other health professionals to recommend the use of e-cigarettes to patients to quit smoking. We aimed to explore GPs’ knowledge, beliefs and intention to recommend e-cigarettes to patients who smoke to support smoking cessation. A sequential, mixed-methods approach was used to explore GPs’ perceptions of e-cigarettes for use in smoking cessation. Survey questions and interviews assessed GPs knowledge, beliefs and recommendations of e-cigarettes as smoking cessation aids. The knowledge, beliefs and intention to recommend e-cigarettes were quantitively described and their recommendation was compared by levels of confidence, and thematic analysis was used for qualitative interview data. A total of 84 survey questionnaires and 7 interviews were completed with GPs from the UK. Results indicated GPs had limited knowledge about e-cigarettes (mean = 2.1 out of 5 questions answered correctly) but held largely positive beliefs about them (e.g. 80% agreed e-cigarettes were less harmful than conventional cigarettes). The majority were willing to recommend e-cigarettes to patients for smoking cessation (60%). Variations in confidence levels about e-cigarettes influenced GPs intentions to recommend them ( p < 0.001). For example, GPs that were confident in their level of knowledge about e-cigarettes were more motivated to recommend them as smoking cessation aids compared with those who were not (91% vs. 45%). Qualitative findings supported results from the quantitative study. GPs interviewed were optimistic about the role of e-cigarettes as smoking cessation aids but also felt they had insufficient knowledge about them. They held mixed perceptions about the evidence supporting use of e-cigarettes for smoking cessation, indicating that more evidence and research is needed to confidently recommend e-cigarettes to patients as smoking cessation aids. GPs in this study had limited knowledge but generally held positive views about e-cigarettes as smoking cessation aids. Confidence in discussing and recommending e-cigarettes varied, with those willing to recommend them feeling more confident in engaging with patients. These findings highlight the need for clearer guidelines and targeted training to support evidence-based advice on e-cigarettes as smoking cessation aids, including their safety, effectiveness and use in clinical practice. Not applicable.