LAUSR

Smoke-free environments in tuberculosis (TB) facilities promote a tobacco-free lifestyle among patients and healthcare providers and advance their healthy image. Though the national law of Armenia prohibits indoor smoking in healthcare facilities, enforcement of the law is still insufficient. This study aimed to explore compliance with the smoke-free policy in TB facilities in Armenia. An exploratory sequential mixed-methods study was conducted. Overall 21 TB physicians and five key informants in the field of TB and tobacco control participated in qualitative interviews. To further quantify and validate the findings, structured observations of smoke-free policy implementation were conducted in 36 facilities. All physicians expressed a positive attitude towards the smoke-free environment and were satisfied with the level of implementation of a smoke-free policy in their TB facilities. According to the respondents, they already have smoke-free environments established in their facilities. “No smoking” signs, warnings about health consequences and financial penalties, and pictures of damaged lungs were the most common measures against indoor smoking. However, only in 17.1% (n = 6) and 8.6% (n = 3) of observed TB facilities there were posted “No smoking” signs and financial penalties, respectively. In 5.7% (n = 2) of facilities, the research team found ashtrays inside the building, and in 20.0% (n = 7) of facilities, there were smoking patients, physicians, and visitors. While the qualitative study indicated good compliance, the quantitative findings were controversial with this regard. In fact, in most of the facilities, the smoke-free policy was not properly implemented and enforced. Additional efforts are needed to harmonize the current practices with national policies and recommendations. There was a discrepancy between practices reported by physicians and the actual observed compliance. Further interventions are needed to ensure 100% compliance with smoke-free policy in TB healthcare facilities.