Smoking cessation readiness among frontline healthcare workers in Malawi: a multicenter cross-sectional study

Frontline healthcare workers are well positioned to deliver smoking cessation interventions, yet their preparedness to do so in low-resource settings remains poorly understood. This study assessed the knowledge, practices, and smoking cessation (SC) readiness of frontline healthcare workers in Malawi. We conducted a multicenter baseline cross-sectional survey among 335 frontline healthcare workers in Lilongwe and Mzimba North districts, Malawi. Data were collected using a structured digital questionnaire capturing sociodemographic characteristics, prior training exposure, knowledge of nicotine addiction and cessation techniques, clinical practices, confidence in delivering cessation support, and perceived barriers. Composite knowledge and practice scores were constructed by summing item-level responses across predefined domains, with higher scores indicating greater knowledge and better cessation-related practice. Descriptive statistics, bivariate comparisons, and multivariate linear and logistic regression analyses were performed. Models were fitted using complete-case analysis, with sample size varying slightly because of item-level missingness. Knowledge gaps were substantial in Tobacco Harm Reduction (THR) and SC programs with only 7.5% and 6.9% of participants reporting prior training in THR and SC, respectively. Further, only 8.4% reported advanced understanding of nicotine addiction. Awareness of nicotine replacement therapy was 30.1%, and motivational interviewing was recognized by 26.6% of the study participants. Practice gaps were similarly pronounced with only 21.8% reporting “able to assess smoking status often or always during routine care”, 42.1% reporting being no familiar with the 5 A approach, and only 9.9% had ever referred a client to a cessation resource. Lack of knowledge was the most frequently reported barrier (60.6%). Despite these gaps, 48.4% reported being very confident in helping clients quit smoking, and 95.8% expressed strong interest in receiving further training. Prior smoking cessation training was strongly associated with higher knowledge in THR interventions ( p < 0.001). Moreover, higher knowledge scores were independently associated with improved practice ( p < 0.001). Frontline healthcare workers in Malawi express strong interest in improving their skills and widely recognize the importance of addressing tobacco use, yet remain insufficiently prepared to deliver effective smoking cessation interventions. Addressing critical gaps in training, knowledge, and system support represents an important opportunity to strengthen tobacco control efforts in Malawi and similar low-resource settings.