Tobacco use treatment (TUT) remains largely absent from Lebanon’s primary healthcare system, even though smoking prevalence ranks among the highest in the region. Although Lebanon has ratified the WHO Framework Convention on Tobacco Control, TUT has not been integrated into routine care. This study describes the adaptation of evidence-based, phone-delivered TUT strategies for integration within Lebanon’s primary healthcare network.

We conducted an explanatory sequential mixed-methods study. Data sources included surveys (n=107) and semistructured interviews (n=24) with healthcare providers, focus group discussions with patients who smoke (n=61) and workflow assessments of 24 primary healthcare centres. Quantitative data were analysed descriptively, and qualitative data underwent rapid framework analysis. We coded adaptations using the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME).

Adaptations were informed by contextual determinants, including gaps in electronic health record infrastructure, patients’ mental health needs, and misconceptions and social norms surrounding waterpipe use. Additional considerations included provider-level constraints, such as limited time to promote tobacco cessation (47% of providers reported having sufficient time), limited cessation training (42% reported sufficient knowledge of pharmacotherapy and 15% reported knowledge of how to prescribe cessation medications) and low confidence in counselling patients about the risks and benefits of these medications (50%). Adaptations included adding paper-based reminders to address variability in electronic health record systems; providing concise, role-specific materials and nicotine replacement therapy guidance for providers; incorporating mental health referral pathways and strengthening counselling content on the harms of waterpipe use; substituting nicotine patches with nicotine gum due to product availability; and developing instructional videos and self-help materials to support implementation.

Tailoring implementation strategies to contextual realities in Lebanon aimed to improve the relevance, feasibility and potential uptake of TUT. This formative study provides an example of a data-driven, stakeholder-engaged approach to adapting evidence-based TUT for low-resource primary healthcare settings.

NCT05628389.

To inform the adaptation of an existing tobacco use treatment (TUT) programme into a contextually appropriate service for Lebanon’s safety-net primary care system.

In-person focus group discussions with an in-depth thematic analysis.

Two primary healthcare centres in Beirut, Lebanon

61 individuals who smoked cigarettes (n=36) and waterpipe (n=25).

The analysis revealed four primary themes: 1) smoking as a coping mechanism for national crisis, 2) lack of perceived fit of the programme with the Lebanese context, 3) differing perceptions of harm and addiction by tobacco product, 4) perceived effectiveness of programme components. Participants reported that smoking helped them cope with stress resulting from the national crisis and felt that patient education material did not reflect local norms around tobacco use. Participants’ views on the relative harm and addictiveness of cigarettes and waterpipe were often discussed in the context of differing use patterns. Addressing mental health, using competent and non-judgmental counsellors, and sharing real-life success stories were recommended to improve engagement in TUT.

Tobacco is embedded within the Lebanese social and cultural life. Our findings inform implementation efforts by identifying contextual needs specific to the Lebanese population that smokes. Tailoring TUTs can increase acceptability, effectiveness and sustainability of smoking cessation efforts in Lebanon and similar low-resource contexts.