Evaluation of Smoke-Free Area Policy Implementation in Sragen Regency: A Qualitative Study of Governance, Enforcement, and Health Communication

Authors

  • Meidyan Thomas Setiawan Master's Program in Public Health, Faculty of Medicine, Universitas Sebelas Maret, Indonesia
  • Eti Poncorini Pamungkasari Faculty of Medicine, Universitas Sebelas Maret, Indonesia
  • Revi Gama Hatta Novika Master's Program in Public Health, Faculty of Medicine, Universitas Sebelas Maret, Indonesia
  • Argyo Demartoto Department of Sociology, Faculty of Social and Political Sciences, Universitas Sebelas Maret, Indonesia
  • Ratih Puspita Febrinasari Department of Pharmacology, Faculty of Medicine, Universitas Sebelas Maret, Indonesia

DOI:

https://doi.org/10.26911/

Abstract

Background: Sragen Regency has adopted a smoke-free area policy; however, its implementation continues to face challenges related to governance, enforcement, health communication, and compliance. This study aimed to evaluate the implementation of the smoke-free area policy in Sragen Regency, with a focus on governance, enforcement, and health communication

Subjects and Method: This qualitative study used an embedded case study design and was conducted from February to June 2026 within the Sragen Regency Government setting, including the Integrated Government Office Complex and selected subdistrict offices. Informants were purposively selected based on their involvement in smoke-free policy implementation, with recruitment continuing until data saturation was reached. In-depth interviews were conducted with 19 informants, comprising seven key informants, eight primary informants, and four supporting informants. Two focus group discussions (FGDs) involved 19 participants. Data were collected through in-depth interviews, FGDs, field observations, and document review. Policy implementation was evaluated using the Context, Input, Process, and Product (CIPP) framework. Data were analyzed using the interactive model of Miles, Huberman, and Saldaña. Trustworthiness was strengthened through source and method triangulation.

Results: Smoke-free policy implementation was supported by local regulations, acceptance among government employees, no-smoking signs, and monitoring activities. Enforcement largely relied on persuasive approaches, including interpersonal communication, social monitoring, direct verbal reminders, and leadership by example, rather than formal sanctions. Organizational culture, social norms, leadership involvement, designated smoking areas, the physical environment, and informal communication influenced compliance. The implementation of the smoke-free policy improved workplace comfort; however, compliance remained uneven.

Conclusion: Smoke-free policy implementation was influenced by governance arrangements, predominantly persuasive enforcement, and health communication that largely occurred through interpersonal interactions. Stronger implementation management, supervision, monitoring and evaluation, and more systematic health communication are needed to improve the consistency of smoke-free policy implementation.

Keywords:

smoke-free area, policy implementation, health communication

Published

16-05-2026

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How to Cite

Evaluation of Smoke-Free Area Policy Implementation in Sragen Regency: A Qualitative Study of Governance, Enforcement, and Health Communication. (2026). Journal of Health Policy and Management, 11(2), 185-195. https://doi.org/10.26911/

How to Cite

Evaluation of Smoke-Free Area Policy Implementation in Sragen Regency: A Qualitative Study of Governance, Enforcement, and Health Communication. (2026). Journal of Health Policy and Management, 11(2), 185-195. https://doi.org/10.26911/

References

Azagba S, Ebling T, Korkmaz A, Jensen JK, Qeadan F, Hall M (2025). State preemption repeal: A pathway to broader smoke-free indoor air policies in the U.S. Am J Prev Med. 68(6): 1142–1149. doi: 10.1016/j.amepre.2025.02.019.

Azis M, Nurlaini F, Brigitha M, Ardiansyah F, Ardiansyah R, Adinugroho A (2025). Persepsi dan kepatuhan masyarakat terhadap implementasi kebijakan Kawasan Tanpa Rokok di lingkungan stasiun kereta api (Public Perceptions and Compliance with the Implementation of Smoke-Free Area Policies in Railway Station Environments). Jurnal Penelitian Administrasi Publik. 7(1): 1–10. doi: 10.32834/jpap.v7i1.990.

Barry RA, Hiilamo H, Glantz SA (2022). Advancing whole-of-government approaches to tobacco control: Article 5.3 and the challenge of policy coordination. Tob Control. 31(1): s46–s51. doi: 10.1136/tobaccocontrol-2021-057154.

Bidja I (2021). Pelaksanaan Peraturan Daerah tentang Kawasan Tanpa Rokok (Implementation of Local Regulations on Smoke-Free Areas). Jurnal Wawasan Yuridika. 5(1): 1–18. doi: 10.25072/jwy.v5i1.381.

Boderie NW, Sheikh A, Lo E, Burdorf A, van Lenthe FJ, Mölenberg FJM, Been JV (2023). Public support for smoke-free policies in outdoor areas and (semi-) private places: A systematic review and meta-analysis. EClinicalMedicine. 59: 101982. doi: 10.1016/j.eclinm.2023.101982.

Jooren SJA, Garritsen HH, Troelstra S, van Dijk W, Jansen MWJ, Willemsen MC, Bommelé J (2025). Compliance with smoke-free policies in outdoor settings: A realist review. Prev Med. 199: 108361. doi: 10.1016/j.ypmed.2025.108361.

Magfirah, Putra AP, Muzaffar, Nurlaely HS (2026). Hubungan pengetahuan dan sikap terhadap perilaku merokok petugas kesehatan Kawasan Tanpa Rokok (KTR) Rumah Sakit Umum Fandika (The Relationship Between Knowledge and Attitudes and Smoking Behavior among Healthcare Workers in the Smoke-Free Area of Fandika General Hospital). Jurnal Ilmiah Cerebral Medika. 7(2). doi: 10.53475/jicm.v7i2.222.

Martini S, Artanti KD, Hargono A, Widati S, Ahsan A, Prabandari YS (2022). Association between percentage of smokers and prevalence of smoking attributable morbidity in Indonesia: One decade after implementation of smoke-free area regulation. BMC Public Health. 22(1): 2202. doi: 10.1186/s12889-022-14435-8.

Miles MB, Huberman AM, Saldaña J (2014). Qualitative data analysis: A methods sourcebook. 3rd ed. Thousand Oaks, CA: Sage Publications.

Ridwan M, Noerjoedianto D, Syukrii M, Ahsan A (2025). Revolutionizing healthcare: Unleashing the power of regulatory measures to enforce smoke-free policies in Indonesian medical facilities. Health Promot Perspect. 15: 295–303. doi: 10.34172/hpp.025.43146.

Shiddiqy MIA, Saputra F, Yulia D (2024). Strategi implementasi kebijakan Kawasan Tanpa Rokok (KTR) di wilayah kerja Kecamatan Jambi Selatan Kota Jambi (Strategies for Implementing Smoke-Free Area (KTR) Policies in the Working Area of Jambi Selatan Subdistrict, Jambi City). Jurnal Ilmu Kesehatan Masyarakat. 13(6): 418–428. doi: 10.33221/jikm.v13i06.3264.

Sufri S, Nurhasanah N, Ahsan A, Saputra I, Jannah M, Yeni CM, Mardhiah A, Bakri S, Usman S (2023). Barriers and opportunities for improving smoke-free area implementation in Banda Aceh City, Indonesia: A qualitative study. BMJ Open. 13(12): e072312. doi: 10.1136/bmjopen-2023-072312.

Widati S, Martini S, Artanti KD, Megatsari H, Wiseman N, Harris N (2022). The advocacy and communication of smoke-free area regulation in East Java, Indonesia. Indonesian Journal of Health Administration. 10(2): 232–240. doi: 10.20473/jaki.v10i2.2022.232-240.

Willemsen MC, Been JV (2022). Accelerating tobacco control at the national level with the Smoke-free Generation movement in the Netherlands. NPJ Prim Care Respir Med. 32(1): 58. doi: 10.1038/s41533-022-00321-8.

World Health Organization (2023). WHO report on the global tobacco epidemic 2023: Protect people from tobacco smoke. Retrieved from https://www.who.int/publications/i/item/9789240077164.

Yin RK (2018). Case study research and applications: Design and methods. 6th ed. Thousand Oaks, CA: Sage Publications.

Yunarman S, Munandar A, Ahsan A, Akbarjono A, Kusuma D (2021). Opportunities and challenges of tobacco control policy at district level in Indonesia: A qualitative analysis. Asian Pac J Cancer Prev. 22(10): 3237–3244. doi: 10.31557/APJCP.2021.22.10.3055.