BACKGROUND: Over 370 sub-national jurisdictions in Indonesia have adopted 100% smoke-free laws but implementation remains a challenge. Several jurisdictions have demonstrated successful implementation of smokefree laws, including Bogor, Kulon Progo, and Klungkung. To better understand what has led to successful implementation in these cities, an evaluation was conducted to identify facilitators and barriers in implementing these laws.
METHODS: The evaluation was conducted in three cities and had two arms, focus group discussions, and in-depth qualitative interviews. Interview materials followed tobacco control-specific constructs outlined in the academic paper "Improving the implementation of tobacco control policies in low-and middle-income countries: a proposed framework’ and were applied to the Consolidated Framework for Implementation Research. Key stakeholders in each city were interviewed on their experiences implementing smoke-free policies, focusing on activities. FGDs included a sample of stakeholders comprised of retailers, venue managers, and enforcement officers. Questions covered knowledge and opinion of the law, perceived benefits, and implementation challenges. Interviews (n=X) and FGDs (n=X) were recorded, transcribed and then coded into the constructs, grouping into sub-constructs to identify facilitators and barriers to implementation.
RESULTS: Results showed common themes between the cities that lead to successful implementation. For example, strong political commitment, specifically engagement from the Mayor in each city, facilitated implementation. Tobacco industry interference was a common barrier between the cities, specifically evolving tactics deployed by the industry. The results also highlighted differences in implementation facilitators and barriers and displayed how each city adapted to their specific context to support implementation. For example, Klungkung created favorable social and political climate by engaging religious leaders and integrating TC policy with religious laws.
CONCLUSIONS: This evaluation showcased common facilitators and barriers that can impact implementation and enforcement of tobacco control policy. Findings can be used to inform effective future interventions for cities/districts implementing TC laws.