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

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)

Journal of Health Policy and Management
Vol. 11 No. 2 (2026)

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.