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Exploring smoking cessation experiences among persons with spinal cord injury: Informing theory-based recommendations for interventions


Study design

Qualitative study.


Use an integrated knowledge translation (IKT) and theory-based approach, to (1) explore factors influencing smoking cessation behaviour among people with SCI, and (2) explore the preferred intervention and implementation options for smoking cessation interventions for persons with SCI.




Aligned with an IKT approach, an SCI organization was meaningfully engaged throughout the research process. Semi-structured interviews were conducted with people with SCI who have quit or tried to quit smoking. Barriers and facilitators to smoking cessation were extracted and deductively coded using the Theoretical Domains Framework (TDF) and inductively analysed. To identify intervention options, a behavioural analysis was conducted using the Behaviour Change Wheel. To identify implementation options, modes of delivery and intervention messengers were extracted. Modes of delivery were deductively coded, and themes relating to intervention messengers were constructed.


Among the 12 participants (7 males; 6 with tetraplegia), seven had quit and five had relapsed. Across the 12 interviews, 130 barriers and 218 facilitators were coded to the TDF. The prominent TDF domains were beliefs about consequences, social influences, environmental context and resources, and behavioural regulation, and served as themes in the inductive analysis. Multiple modes of delivery and intervention messengers were considered important for the delivery of smoking cessation interventions.


This study is the first to use IKT and theory-based approaches to explore factors influencing smoking cessation among persons with SCI. Findings from this study resulted in the co-development of practical recommendations for future SCI-specific smoking cessation interventions.

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Fig. 1: Barriers to smoking cessation by COM-B source and TDF domain (n = 141).
Fig. 2: Facilitators to smoking cessation by COM-B source and TDF domain (n = 233).
Fig. 3

Data availability

The data that support the findings of this study are available from the corresponding author on reasonable request. The data are not publicly available due to privacy or ethical reasons.


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We would like to acknowledge Emily Stone, Jiawin Lim, Lexington Kinnear, and Kylie Lundberg-Dorr for their help with interview transcription. We would also like to acknowledge Spinal Cord Injury British Columbia for their efforts with recruitment. The research team also acknowledges all participants for their time participating in the interviews.


HLG is supported by a Michael Smith Health Research BC Scholar Award (Formerly MSFHR, Canada, no. 16910). KRW is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship—Doctoral Award (no. 175909).

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Authors and Affiliations



KRW, CBM, and HLG were responsible for co-developing the research question, selecting the methodology, co-developing all recruitment materials, and co-developing the interview guide. KRW conducted all interviews. KRW and JDB extracted and deductively coded all transcripts. HLG provided coding oversight. KRW inductively coded all transcripts. FH and HLG acted as critical friends and provided feedback on the thematic analysis. CBM provided partner oversight. HLG supervised the research. KRW wrote the manuscript. All authors contributed to the critical revision of the manuscript.

Corresponding author

Correspondence to Kelsey R. Wuerstl.

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Competing interests

The authors declare no competing interests.

Ethical approval

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. Ethics approval for this study was obtained from the University of British Columbia Okanagan Behavioural Research Ethics Board (#H19–01020).

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Wuerstl, K.R., McBride, C.B., Deschênes-Bilodeau, J. et al. Exploring smoking cessation experiences among persons with spinal cord injury: Informing theory-based recommendations for interventions. Spinal Cord 61, 27–36 (2023).

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