Background/Purpose: Patients with rheumatoid arthritis (RA) may experience specific barriers
to smoking cessation but may also be motivated to quit to improve their health,
particularly if informed of the possible impact of smoking on disease activity,
treatment efficacy, and outcomes. Qualitative research on the perspectives of
smokers and ex-smokers with RA is needed to help design, implement, and
evaluate smoking cessation interventions that can be applied in clinical
practice if efficacious.

Methods: Semi-structured interviews were carried out with 29 ongoing smokers
and 10 ex-smokers with RA who had previously been invited to participate in a randomized
controlled trial of a novel RA-specific smoking cessation intervention (14/19
in the intervention group; 14/19 in the control group; 11/18 who had declined
being in the trial). The interviews were led by a researcher with no
involvement in the participants’ clinical care. Interview transcripts were
subjected to thematic analysis to investigate the motivations and barriers to
smoking cessation that are most pertinent to RA patients, which led us to
formulate themes outlining what we call ‘incentives’ and ‘drives’ to quit.

Results: Participants described five incentives to quit (health, arthritis,
social relationships, coping mechanism, and costs) and four drives to quit
(commitment, mental preparation, will power, and interventions). In particular,
participants highlighted how their health (in general and relating to their RA)
could provide an incentive to quit or be used as a rationalization for not
having quit. Living with RA contributed to the stress and negative emotions
experienced by participants and also limited the availability of coping methods
that might be used in places of smoking, particularly those coping methods requiring
mobility. None of the 10 participants who had quit smoking mentioned having
previously relied on smoking as a coping method.

Conclusion: When RA patients have been informed that continued smoking may
impact on the outcomes of their RA it can provide an important incentive to
quit smoking that may bolster other general incentives to quit. At the same
time, RA patients experience stress and mobility difficulties that often make
it difficult to quit smoking despite knowing the general and RA-specific health
benefits. Overall, the incentives and drives revealed in this research also
indicate ways that RA patients might be supported in developing the motivation
to quit smoking and ways of overcoming barriers. RA patients who report using
smoking to cope may benefit from psychological interventions to help them
replace or reframe that coping method and bolster other psychological processes
that can drive smoking cessation.