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Watkins A, Stein-Parbury J, Curtis J, Poole J, Teasdale S, Fibbins H, Rossimel E, Lederman O, Ward PB, Rosenbaum S, Denney-Wilson E. Tackling change in mental health service delivery: A qualitative evaluation of a lifestyle program targeting mental health staff - Keeping our Staff in Mind (KoSiM). Health Promot J Austr 2023; 34:237-245. [PMID: 35718992 PMCID: PMC10083901 DOI: 10.1002/hpja.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 01/30/2023] Open
Abstract
ISSUES ADDRESSED People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures. METHODS The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi-structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors. RESULTS Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self-care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program. CONCLUSION The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision. SO WHAT?: A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.
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Affiliation(s)
- Andrew Watkins
- Mindgardens Neuroscience Network, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jackie Curtis
- Mindgardens Neuroscience Network, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Josephine Poole
- Keeping the Body in Mind, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Scott Teasdale
- Mindgardens Neuroscience Network, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Hamish Fibbins
- Mindgardens Neuroscience Network, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Elisa Rossimel
- Keeping the Body in Mind, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Oscar Lederman
- Keeping the Body in Mind, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Hagerman CJ, Hoffman RK, Vaylay S, Dodge T. Implementation Intentions to Reduce Smoking: A Systematic Review of the Literature. Nicotine Tob Res 2021; 23:1085-1093. [PMID: 33220048 DOI: 10.1093/ntr/ntaa235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/17/2020] [Indexed: 11/14/2022]
Abstract
Implementation intentions are a goal-setting technique in which an individual commits to perform a particular behavior when a specific context arises. Recently, researchers have begun studying how implementation intention (II) interventions can facilitate antismoking efforts. The current systematic review synthesized results of experimental studies that tested the effect of an II intervention on smoking cognitions and behavior. Of 29 reviewed articles, 11 studies met inclusion criteria. Nine studies (81.8%) tested an II intervention as a cessation tool for current smokers, whereas two tested II interventions as a tool to prevent smoking among predominantly nonsmoking adolescents. A majority of the studies (66.7%) testing II interventions as a cessation tool reported a positive effect on cessation at long-term follow-up. Of the two studies testing II interventions as a tool for prevention, one study found a positive effect on long-term follow-up. Methodology varied between the studies, highlighting the discrepancies between what researchers consider "implementation intentions" to be. II interventions are a promising tool for antismoking efforts, but more research is necessary to determine the best methodology and the populations for whom this intervention will be most effective. IMPLICATIONS Brief, free, and easily scalable, II interventions to prevent smoking are highly attractive for antismoking efforts. This review outlines the circumstances under which II interventions have demonstrated effectiveness in helping people resist smoking cigarettes. We illuminate gaps in the existing literature, limitations, methodological discrepancies between studies, and areas for future study.
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Affiliation(s)
- Charlotte J Hagerman
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
| | - Rebecca K Hoffman
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
| | - Sruthi Vaylay
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
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Fulton EA, Newby K, Kwah K, Schumacher L, Gokal K, Jackson LJ, Naughton F, Coleman T, Owen A, Brown KE. A digital behaviour change intervention to increase booking and attendance at Stop Smoking Services: the MyWay feasibility RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Smoking remains a leading cause of illness and preventable death. NHS Stop Smoking Services increase quitting, but, as access is in decline, cost-effective interventions are needed that promote these services. StopApp™ (Coventry University, Coventry, UK) is designed to increase booking and attendance at Stop Smoking Services.
Design
A two-arm feasibility randomised controlled trial of StopApp (intervention) compared with standard promotion and referral to Stop Smoking Services (control) was conducted to assess recruitment, attrition and health equity of the design, alongside health economic and qualitative process evaluations.
Setting
Smokers recruited via general practitioners, community settings and social media.
Participants
Smokers aged ≥ 16 years were recruited in one local authority. Participants had to live or work within the local authority area, and there was a recruitment target of 120 participants.
Interventions
StopApp to increase booking and attendance at Stop Smoking Services.
Main outcome measures
Participants completed baseline measures and follow-up at 2 months post randomisation entirely online. Objective data on the use of Stop Smoking Services were collected from participating Stop Smoking Services, and age groups, sex, ethnicity and socioeconomic status in baseline recruits and follow-up completers/non-completers were assessed for equity.
Results
Eligible participants (n = 123) were recruited over 116 days, with good representation of lower socioeconomic status groups; black, Asian and minority ethnic groups; and all age groups. Demographic profiles of follow-up completers and non-completers were broadly similar. The attrition rate was 51.2%, with loss to follow-up lowest in the social media setting (n = 24/61; 39.3%) and highest in the general practitioner setting (n = 21/26; 80.8%). Most measures had < 5% missing data. Social media represented the most effective and cost-efficient recruitment method. In a future, definitive, multisite trial with recruitment driven by social media, our data suggest that recruiting ≥ 1500 smokers over 12 months is feasible. Service data showed that five bookings for the Stop Smoking Services were scheduled using StopApp, of which two did not attend. Challenges with data access were identified. A further five participants in the intervention arm self-reported booking and accessing Stop Smoking Services outside StopApp compared with two control arm participants. Event rate calculations for the intervention were 8% (Stop Smoking Services data), 17% (including self-reports) and 3.5% from control arm self-reports. A conservative effect size of 6% is estimated for a definitive full trial. A sample size of 840 participants would be required to detect an effect for the primary outcome measure of booking a Stop Smoking Services appointment in a full randomised controlled trial. The process evaluation found that participants were satisfied with the research team contact, study methods and provision of e-vouchers. Staff interviews revealed positive and negative experiences of the trial and suggestions for improvements, including encouraging smokers to take part.
Conclusion
This feasibility randomised controlled trial found that, with recruitment driven wholly or mainly by social media, it is possible to recruit and retain sufficient smokers to assess the effectiveness and cost-effectiveness of StopApp. The study methods and measures were found to be acceptable and equitable, but accessing Stop Smoking Services data about booking, attendance and quit dates was a challenge. A full trial may be feasible if service data are accessible. This will require careful planning with data controllers and a targeted social media campaign for recruitment. Changes to some study measures are needed to avoid missing data, including implementation of a more intensive follow-up data collection process.
Future work
We plan a full, definitive randomised controlled trial if the concerns around data access can be resolved, with adaptations to the recruitment and retention strategy.
Limitations
Our trial had high attrition and problems with collecting Stop Smoking Services data, which resulted in a reliance on self-reporting.
Trial registration
Research Registry: 3995. The trial was registered on 18 April 2018.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emily A Fulton
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Katie Newby
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kayleigh Kwah
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lauren Schumacher
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kajal Gokal
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Louise J Jackson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Tim Coleman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Alun Owen
- Faculty of Engineering, Environment and Computing and Sigma Mathematics and Statistics Support Centre, Coventry University, Coventry, UK
| | - Katherine E Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Lee EJ. Factors Predicting 6-Month Smoking Cessation in Korean Adults. Psychiatr Q 2020; 91:703-714. [PMID: 32157547 DOI: 10.1007/s11126-020-09730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to identify factors predicting 6-month smoking cessation in Korean adult smokers. This descriptive correlation study assessed levels of urine cotinine, serum cotinine, serum serotonin, and 5-hydroxyindoleacetic acid; tobacco withdrawal symptoms; and resilience among 164 Korean adult smokers. Serum cotinine levels were negatively related to resilience at six months (r = -.42, p = .019), but were positively related to the amount of smoking (r = .32, p = .008) and with the Week 6 tobacco withdrawal symptoms score (r = .48, p = .001, n = 41). Higher resilience was associated with a higher 5-HIAA concentration. Greater therapy attendance, resilience, and withdrawal symptoms explained 35.3% of the variance in 6-month smoking cessation (Nagelkerke R2 = .35, p < .001, n = 76). Efforts to increase counseling attendance rates and resilience and decrease withdrawal symptoms could be useful ways to improve smoking cessation rates.
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Affiliation(s)
- Eun Jin Lee
- Nursing Department, Inha University, Inharo100, Michuholgu, Incheon, 22212, South Korea.
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Malaguti A, Ciocanel O, Sani F, Dillon JF, Eriksen A, Power K. Effectiveness of the use of implementation intentions on reduction of substance use: A meta-analysis. Drug Alcohol Depend 2020; 214:108120. [PMID: 32622228 DOI: 10.1016/j.drugalcdep.2020.108120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Background: Substance use, such as alcohol drinking, tobacco smoking and illicit drug use, have been associated with severe health conditions and an annual estimated 12 % of all deaths worldwide. Implementation intentions are self-regulatory processes which help achieve health-related behaviour change. OBJECTIVES To investigate the effectiveness of forming implementation intentions to reduce substance use. DESIGN Data sources: PsycINFO, MEDLINE, Psychology and Behavioural Science Collection, clinicaltrials.gov, UK Clinical Trials Gateway, Reference lists. INCLUSION CRITERIA RCT of substance users forming implementation intentions to reduce consumption (active or passive control condition present). STUDY APPRAISAL AND SYNTHESIS METHODS the SIGN checklist for RCT quality was used for quality appraisal, data was extracted by two reviewers. RESULTS Twenty-one studies were included in the meta-analysis. The overall effect size for alcohol use was g = 0.31 (95 % CI: 0.21, 0.42), p < .001; for tobacco smoking g = 0.31 (CI: 0.12, 0.5), p = .002; no studies were retrieved for the use of implementation intentions on illicit drug use. CONCLUSION This review suggests that implementation intention interventions are effective in reducing some forms of substance use (alcohol use and tobacco smoking), albeit revealing small effect sizes, among the general population and students in secondary and higher education. Review registration number: CRD42018116170.
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Affiliation(s)
- Amy Malaguti
- School of Social Sciences (Psychology), University of Dundee, Scrymgeour Building, Park Place, Dundee, DD1 4HN, United Kingdom; Adult Psychological Therapies Service, NHS Tayside, 15 Dudhope Terrace, Dundee, DD3 6HH, United Kingdom; Sexual Health and Blood Borne Virus Managed Care Network, Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee, DD3 8EA, United Kingdom.
| | - Oana Ciocanel
- Adult Psychological Therapies Service, NHS Tayside, 15 Dudhope Terrace, Dundee, DD3 6HH, United Kingdom; Sexual Health and Blood Borne Virus Managed Care Network, Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee, DD3 8EA, United Kingdom
| | - Fabio Sani
- School of Social Sciences (Psychology), University of Dundee, Scrymgeour Building, Park Place, Dundee, DD1 4HN, United Kingdom
| | - John F Dillon
- School of Medicine, Ninewells Hospital, University of Dundee, DD1 9SY, Dundee, United Kingdom; Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Ann Eriksen
- Sexual Health and Blood Borne Virus Managed Care Network, Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee, DD3 8EA, United Kingdom
| | - Kevin Power
- Adult Psychological Therapies Service, NHS Tayside, 15 Dudhope Terrace, Dundee, DD3 6HH, United Kingdom; Faculty of Natural Sciences (Psychology), University of Stirling, Stirling, FK9 4LA, United Kingdom
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Dregan A, McNeill A, Gaughran F, Jones PB, Bazley A, Cross S, Lillywhite K, Armstrong D, Smith S, Osborn DPJ, Stewart R, Wykes T, Hotopf M. Potential gains in life expectancy from reducing amenable mortality among people diagnosed with serious mental illness in the United Kingdom. PLoS One 2020; 15:e0230674. [PMID: 32218598 PMCID: PMC7100972 DOI: 10.1371/journal.pone.0230674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To estimate the potential gain in life expectancy from addressing modifiable risk factors for all-cause mortality (excluding suicide and deaths from accidents or violence) across specific serious mental illness (SMI) subgroups, namely schizophrenia, schizoaffective disorders, and bipolar disorders in a Western population. METHODS We have used relative risks from recent meta-analyses to estimate the population attribution fraction (PAF) due to specific modifiable risk factors known to be associated with all-cause mortality within SMI. The potential gain in life expectancy at birth, age 50 and age 65 years were assessed by estimating the combined effect of modifiable risk factors from different contextual levels (behavioural, healthcare, social) and accounting for the effectiveness of existing interventions tackling these factors. Projections for annual gain in life expectancy at birth during a two-decade was estimated using the Annual Percentage Change (APC) formula. The predicted estimates were based on mortality rates for year 2014-2015. RESULTS Based on the effectiveness of existing interventions targeting these modifiable risk factors, we estimated potential gain in life expectancy at birth of four (bipolar disorders), six (schizoaffective disorders), or seven years (schizophrenia). The gain in life expectancy at age 50 years was three (bipolar disorders) or five (schizophrenia and schizoaffective disorders) years. The projected gain in life expectancy at age 65 years was three (bipolar disorders) or four (schizophrenia and schizoaffective disorders) years. CONCLUSIONS The implementation of existing interventions targeting modifiable risk factors could narrow the current mortality gap between the general and the SMI populations by 24% (men) to 28% (women). These projections represent ideal circumstances and without the limitation of overestimation which often comes with PAFs.
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Affiliation(s)
- Alex Dregan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Anna Bazley
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Sean Cross
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Kate Lillywhite
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - David Armstrong
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Shubulade Smith
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
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Tzelepis F, Paul CL, Williams CM, Gilligan C, Regan T, Daly J, Hodder RK, Byrnes E, Byaruhanga J, McFadyen T, Wiggers J. Real-time video counselling for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD012659. [PMID: 31684699 PMCID: PMC6818086 DOI: 10.1002/14651858.cd012659.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Real-time video communication software such as Skype and FaceTime transmits live video and audio over the Internet, allowing counsellors to provide support to help people quit smoking. There are more than four billion Internet users worldwide, and Internet users can download free video communication software, rendering a video counselling approach both feasible and scalable for helping people to quit smoking. OBJECTIVES To assess the effectiveness of real-time video counselling delivered individually or to a group in increasing smoking cessation, quit attempts, intervention adherence, satisfaction and therapeutic alliance, and to provide an economic evaluation regarding real-time video counselling. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, CENTRAL, MEDLINE, PubMed, PsycINFO and Embase to identify eligible studies on 13 August 2019. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov to identify ongoing trials registered by 13 August 2019. We checked the reference lists of included articles and contacted smoking cessation researchers for any additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), randomised trials, cluster RCTs or cluster randomised trials of real-time video counselling for current tobacco smokers from any setting that measured smoking cessation at least six months following baseline. The real-time video counselling intervention could be compared with a no intervention control group or another smoking cessation intervention, or both. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from included trials, assessed the risk of bias and rated the certainty of the evidence using the GRADE approach. We performed a random-effects meta-analysis for the primary outcome of smoking cessation, using the most stringent measure of smoking cessation measured at the longest follow-up. Analysis was based on the intention-to-treat principle. We considered participants with missing data at follow-up for the primary outcome of smoking cessation to be smokers. MAIN RESULTS We included two randomised trials with 615 participants. Both studies delivered real-time video counselling for smoking cessation individually, compared with telephone counselling. We judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow-up) across the two included studies when real-time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). We judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real-time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI -0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD -0.20, 95% CI -0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI -0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between-group differences on satisfaction score (MD 0.70, 95% CI -1.16 to 2.56; 1 study, 29 participants). AUTHORS' CONCLUSIONS There is very little evidence about the effectiveness of real-time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. High-quality randomised trials comparing real-time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real-time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation.
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Affiliation(s)
- Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Christine L Paul
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
| | - Christopher M Williams
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Conor Gilligan
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Tim Regan
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Justine Daly
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca K Hodder
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Emma Byrnes
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Judith Byaruhanga
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
| | - Tameka McFadyen
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - John Wiggers
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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8
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Kwah KL, Fulton EA, Brown KE. Accessing National Health Service Stop Smoking Services in the UK: a COM-B analysis of barriers and facilitators perceived by smokers, ex-smokers and stop smoking advisors. Public Health 2019; 171:123-130. [PMID: 31128557 DOI: 10.1016/j.puhe.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Smokers who access free National Health Service (NHS) Stop Smoking Services (SSS) in the UK are four times more likely to stop smoking, yet uptake of the services has been in decline in recent years. Evidence was collated to explore the beliefs of smokers, ex-smokers and Stop Smoking Advisors (SSAs) about SSS and the barriers and facilitators to access. STUDY DESIGN Mixed-methods design including i) a search of the literature; ii) a cross-sectional online questionnaire completed by 38 smokers and ex-smokers; and iii) semistructured interviews with 5 SSAs. METHODS PubMed, Web of Science, Scopus, Prospero and the NIHR Portfolio were searched in October 2017 to identify relevant studies. Smokers and ex-smokers were recruited to the online questionnaire via Public Health websites and social media in Warwickshire. SSAs identified via Public Health Warwickshire were invited to take part in an interview conducted over the telephone. Findings were collated and analysed using the COM-B ('Capability', 'Opportunity', 'Motivation' and 'Behaviour') model framework. RESULTS A range of practical and psychological or belief-based barriers and facilitators to accessing SSS were identified within all the components of the COM-B model, aside from physical capability, for example; 'Psychological capability', such as lack of understanding about what the service offers; 'Reflective motivation', such as lack of confidence in service efficacy; and 'Social opportunity', such as recommendations from healthcare professionals to attend. Suggestions and consideration on how future tobacco control intervention and public health messages can address these components are reported. CONCLUSIONS Public health interventions and campaigns may benefit from focussing on addressing the well-known perceived barriers and facilitators smokers experience, in particular focussing on the components of the COM-B that have been identified as being important to increase the uptake of SSS.
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Affiliation(s)
- K L Kwah
- Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK.
| | - E A Fulton
- Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK; Public Health Warwickshire, Warwickshire County Council, Warwick, CV34 4RL, UK
| | - K E Brown
- Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK; Public Health Warwickshire, Warwickshire County Council, Warwick, CV34 4RL, UK
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9
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Fulton E, Newby K, Gokal K, Kwah K, Schumacher L, Jackson LJ, Naughton F, Coleman T, Brown K. Tailored digital behaviour change intervention with e-referral system to increase attendance at NHS stop smoking services (the MyWay project): study protocol for a randomised controlled feasibility trial. BMJ Open 2019; 9:e028721. [PMID: 30962245 PMCID: PMC6500333 DOI: 10.1136/bmjopen-2018-028721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION In the UK, smokers who use stop smoking services (SSSs) are four times more likely to stop smoking than smokers who do not. Attendance has declined, warranting the development of interventions to address this. StopApp is a novel, brief online behaviour change intervention designed to address common barriers to SSS attendance. It links to widely commissioned service management software that enables instant appointment booking at a user's location and time of choice. METHODS AND ANALYSIS A two-arm parallel group, individual participant feasibility randomised controlled trial of StopApp (intervention) compared with the standard promotion of and referral to SSSs (control). The study includes a nested qualitative process evaluation to assess the acceptability of the research processes, with a subsample of participants. Smokers aged over 16 years will be recruited via three routes: General Practice (GP), community settings and online. After consenting and the collection of baseline data, participants will be randomised to control or intervention groups. Participants in the intervention group receive a link to StopApp and those in the control group receive standard web-based information about the SSSs. All participants are told they can book a SSS appointment but are under no obligation to do so. Online follow-up 2 months post randomisation includes data on SSS use and carbon monoxide verified 4-week quit rates. The study aims to recruit 162 smokers. ETHICS AND DISSEMINATION Ethics approval has been granted by the West Midlands-Edgbaston NHS Research Ethics Committee. The findings will be reported in conferences and peer-reviewed publications; and will be used to design the parameters necessary for a definitive trial to ascertain the effectiveness of StopApp at increasing booking and attendance at SSSs compared with existing methods for encouraging uptake.
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Affiliation(s)
- Emily Fulton
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Katie Newby
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Kajal Gokal
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Kayleigh Kwah
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Lauren Schumacher
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Tim Coleman
- Division of General Practice, University of Nottingham, Nottingham, UK
| | - Katherine Brown
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
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Fraenkel L, Reyna V, Cozmuta R, Cornell D, Nolte J, Wilhelms E. Do visual aids influenced patients' risk perceptions for rare and very rare risks? PATIENT EDUCATION AND COUNSELING 2018; 101:1900-1905. [PMID: 30305252 PMCID: PMC6190580 DOI: 10.1016/j.pec.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To examine whether visual aids (a graphic representation and/or conceptual illustrations) influence patients' risk perceptions for rare and very rare risks. METHODS Participants were randomized to a scenario which varied by probability of infection (2% or 0.2%) and visual aid: numbers only, numbers + graphic representation, numbers + conceptual illustrations, or numbers + graphic representation + conceptual illustrations. Risk perceptions and likelihood of starting the medication were examined across the four formats, separately, in participants with and without a college education. RESULTS Adding a graphic representation and/or conceptual illustrations did not affect risk perceptions among those with a higher level of education. Adding both a graphic representation + conceptual illustrations decreased risk perceptions and increased likelihood of starting the medication among participants randomized to the 2%, but not 0.2% scenario, among participants with lower levels of education. CONCLUSION Adding a graphic representation + conceptual illustrations to numbers may influence perceptions for rare, but not very rare, risks among patients with lower education. PRACTICE IMPLICATIONS Clinicians should be aware of the differential effects of visual aids developed to facilitate risk communication. Patients with higher levels of education may be less responsive to visual aids than those with lower education.
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Affiliation(s)
- Liana Fraenkel
- Department of Medicine, Yale University, New Haven, USA; VA Connecticut Healthcare System, West Haven, USA.
| | - Valerie Reyna
- Human Neuroscience Institute, Cornell University, Ithaca, USA
| | | | - Diana Cornell
- Department of Medicine, Yale University, New Haven, USA
| | - Julia Nolte
- Human Neuroscience Institute, Cornell University, Ithaca, USA
| | - Evan Wilhelms
- Department of Psychology, The College of Wooster, Wooster, USA
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Tzelepis F, Paul CL, Williams CM, Gilligan C, Regan T, Daly J, Hodder RK, Wiggers J. Real-time video counselling for smoking cessation. Hippokratia 2017. [DOI: 10.1002/14651858.cd012659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Flora Tzelepis
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Christine L Paul
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
| | - Christopher M Williams
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Conor Gilligan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
| | - Tim Regan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Justine Daly
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Rebecca K Hodder
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - John Wiggers
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
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12
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Baha M, Boussadi A, Le Faou AL. French smoking cessation services provide effective support even to the more dependent. Prev Med 2016; 90:34-8. [PMID: 27346755 DOI: 10.1016/j.ypmed.2016.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/14/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE France is one the few European countries offering a national quit line along with partially cost-covered nicotine replacement therapy (NRT) and cessation services. This study assesses outcomes and predictors of continued abstinence in French smoking cessation services. METHOD The French national smoking cessation registry (CDTnet) included 23,810 adult smokers followed-up between 2011 and 2013. We assessed 1-month continued abstinence among 10,161 who initiated a quit attempt before or during follow-up. Predictors of abstinence were determined using multivariable regression model. RESULTS Among quitters, 45.2% achieved CO-validated abstinence. Prescription of pharmacotherapy was associated with abstinence rates as high as 47% for combination NRT and 53% for varenicline. The effect of behavioural support associated with combination NRT versus behavioural support alone increased with attendance: OR 1.11 (95% CI 0.89-1.39) for 2-3 visits, OR 1.43 (95% CI 1.13-1.80) for 4-6 visits, OR 1.60 (95% CI 1.21-2.12) for ≥7 visits. Unemployed participants were as likely to be successful as participants in employment (OR 0.88; 95% CI 0.75-1.04). High cigarette dependence also did not significantly hinder abstinence. Young adults achieved the lowest abstinence rates. Predictors that significantly reduced odds of abstinence were: being aged 18 to 24 and a history of alcohol abuse. CONCLUSION With adapted treatment, even the more dependent or less affluent maintained abstinence. Our findings suggest that French cessation services have been successful in providing cessation support. Nevertheless, there is room for improvement in tailoring treatment for some subgroups of smokers.
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Affiliation(s)
- Monique Baha
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France.
| | - Abdelali Boussadi
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France; INSERM UMRs 1138, équipe 22, Paris, France
| | - Anne-Laurence Le Faou
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, UMRS1123, Hôtel-Dieu 1, place du Parvis Notre-Dame, F-75004 Paris, France
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StopApp: Using the Behaviour Change Wheel to Develop an App to Increase Uptake and Attendance at NHS Stop Smoking Services. Healthcare (Basel) 2016; 4:healthcare4020031. [PMID: 27417619 PMCID: PMC4934584 DOI: 10.3390/healthcare4020031] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022] Open
Abstract
Smokers who attend NHS Stop Smoking Services (SSS) are four times more likely to stop smoking; however, uptake has been in decline. We report the development of an intervention designed to increase uptake of SSS, from a more motivated self-selected sample of smokers. In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. In Phase 2, data from extant literature and Phase 1 were subject to behavioural analysis, as outlined by the Behaviour Change Wheel (BCW) framework. Relevant Behaviour Change Techniques (BCTs) were identified in order to address these, informing the content of the StopApp intervention. In Phase 3 we assessed the acceptability of the StopApp. Smokers and ex-smokers identified a number of barriers to attending SSS, including a lack of knowledge about what happens at SSS (Capability); the belief that SSS is not easy to access (Opportunity); that there would be ’scare tactics’ or ‘nagging’; and not knowing anyone who had been and successfully quit (Motivation). The ‘StopApp’ is in development and will link in with the commissioned SSS booking system. Examples of the content and functionality of the app are outlined. The next phase will involve a full trial to test effectiveness.
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Sohanpal R, Steed L, Mars T, Taylor SJC. Understanding patient participation behaviour in studies of COPD support programmes such as pulmonary rehabilitation and self-management: a qualitative synthesis with application of theory. NPJ Prim Care Respir Med 2015; 25:15054. [PMID: 26379121 PMCID: PMC4588031 DOI: 10.1038/npjpcrm.2015.54] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical. AIMS The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes. METHODS Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes. RESULTS Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' and 'illness' and 'intervention representations'. The following factors influenced (1) attendance-helping oneself through health improvements, perceived control of worsening condition, perceived benefits and positive past experience of the programme, as well as perceived positive influence of professionals; (2) non-attendance-perceived negative effects and negative past experience of the programme, perceived physical/practical concerns related to attendance, perceived severity of condition/symptoms and perceived negative influence of professionals/friends; (3) dropout-no health improvements perceived after attending a few sessions of the programme, perceived severity of the condition and perceived physical/practical concerns related to attendance. CONCLUSIONS Psychosocial factors including perceived practical/physical concerns related to attendance influenced patients' participation in COPD support programmes. Addressing the negative beliefs/perceptions via behaviour change interventions may help improve participation in COPD support programmes and, ultimately, patient outcomes.
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Affiliation(s)
- Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Thomas Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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