Participation of health professionals in a research intervention
Health professionals did not report high satisfaction with their participation in the study. They mostly did not report gaining more information about NRT and e-cigarettes, discussing smoking cessation more often, or changing their perception concerning the desire to quit among low SEP populations. However, one of the goals of the study is to prove that giving free cessation tools to these patients according to their own choice would lead to greater success in quitting smoking. The professionals most convinced that this intervention would allow them to better help their patients, or would allow a better adherence to the care of their patients, were the smoking cessation specialists and the medical doctors.The most frequently cited barriers and constraints related to participating in the study were the lack of time combined with the already present heavy workload. Indeed, since the investigating centers are public hospitals or health centers, the lack of staff and the influx of patients beyond capacity can make research take second place to care. Consultations must be quick and efficient in order to see as many patients as possible, and the addition of time that is not strictly necessary is perceived as burdening and therefore denied. The SESMAT qualitative survey [Health professionals may also have been uncomfortable by the content of some questions in the questionnaire, such as questions on socio-economic background by fear of stigma. They reported that it could be complicated to submit it into the middle of a specific appointment, and that it may strain the already fragile therapeutic alliance with low SEP patients. Moreover, due to lack of time, sometimes these questionnaires replaced routine questioning that the professional would have liked to carry out. Thus, it may be considered more relevant to separate the time of care and the time of research by avoiding integrating the data collection in the consultation. In addition, they may be apprehensive about patients’ reluctance to participate in research. Patients may experience it as a “test”, and this may weaken the physician-patient trust relationship. Finally, health care professionals are sometimes not well trained in research and may be afraid of making errors and distorting the study.Our results are consistent with a qualitative study on perceptions of recruiters in six Randomized Control Trials (RCTs) [Our results highlight the desire of some health professionals to separate research time from clinical practice time. However, the aim of this pragmatic research, and therefore of the pragmatic trial, was to integrate research into routine, so that the intervention would be as close as possible to real-life conditions. This is so the intervention could be more easily generalized outside the research context.Some professionals did have positive feedback on the integration of the intervention into their medical practice: it allowed them to refocus on patient preferences and thus improve their patient-centered approach to care. The co-construction of interventions with the target audience is indeed a criterion of effectiveness according to a synthesis of the literature conducted by Guignard et al. on smoking cessation interventions in low SEP patients [A qualitative study asked key stakeholders about the challenges raised by pragmatic trials [Finally, in real life, health professionals are confronted with specific problems while treating low SEP patients. This is why a pragmatic trial specifically tailored to this population has been set up. However, these same issues recur as barriers to the implementation of the research, which illustrates all the complexity of pragmatic trials not just those targeting individuals with lown SEP.