Eof computer-tailored Smoking Cessation Advice in Primary carEffectiveness

Hazel Gilbert, Irwin Nazareth and Richard MorrisDepartment of Primary Care and Population Sciences, UCL

Stephen SuttonInstitute of Public Health, University of Cambridge

General PracticeResearchFramework

Developing tailored interventions for smoking cessation in primary care: the background to the ESCAPE trial

To examine the effect of computer-generated individually tailored feedback reports on quit rates and quitting activity, when sent to smokers with varying levels of motivation and reading ability, identified from GP lists.

ESCAPE – The Aim

Smoking is the leading preventable cause of disease and death

Smoking is a modifiable behaviour

Intensive face-to-face or group therapy most effective treatment

ESCAPE – The Background

NHS Smoking Cessation Service

Low participation rates

• 6% of smokers use the services per year• 97% one to one / 3% groups

Relatively high quit rates

• 52 week abstinence rate 15%• 1% of smokers helped to stop long-term

Challenges for Primary Care

* To increase success rates in clinics

* Bridge the gap between clinical and public health approach

* Reach the smokers who do not use clinics

Self help Materials

Generic leaflets and manuals

Targeted materials to particular groups

Individually tailored feedback defined as:

‘intended to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment’ (Kreuter et al 1999)

Feasibility of and response rates to proactive recruitment in general practice Response from practices

encouraging Range of list sizes (6400 to

16000) Range of levels of deprivation % of identified smokers 8-23 Corresponds with deprivation

scores Mean response rate 8.9% Mean 3-month follow-up

response rate 66.7%

Female 53.8%

Mean age 42.1

≥Degree level 52.6%

Low Literacy level 23.1%

Planning to quit:

next 2 weeks 10.3 %

next 30 days 14.1 %

next 6 months 42.3 %

not planning 32.1 %

Characteristics of respondents

Focus groups to assess perception and reaction to computer tailored feedback

Females 

‘Yes, if I had got one of these, something tailored to what I said on my questionnaire, I would have been quite pleased, something just for me.’

‘They are actually bothering with me and, because I have sent in the questionnaire, you actually want me to quit. You know what I mean, I think it is pretty good.’

‘I think the best thing is that it is aimed at an individual unlike the leaflets which are an overall thing.’

Males  ‘There is a strong reassurance, it’s an expression of support. I

like the basic concept, I like the idea of a tailored letter in response to a questionnaire, I like the idea of having that sort of personal support.  ----- It looks like a chain letter even though it is trying not to be.’

‘Yes it looks a bit like a template that’s just been printed off.’

‘You know, once I have written a questionnaire saying I am giving up, I am giving up for health reasons, I don’t really need to be told that smoking is dangerous for you.’

 ‘(If) I opened and I saw all that writing, you know I would, it would

go in the bin. It needs more pictures, it needs to be more, like, more grabbing to you, so that you want to read it.’

recruit 100 MRC GPRF practices, selected to represent high and low socio-economic areas

each practice select a random sample of 500 current cigarette smokers, aged between 18 and 65

selected patients (n=50,000) sent the Smoking Behaviour Questionnaire (SBQ), together with a covering letter from their GP

an estimated response rate of 15% from 2 mailings (reminder and duplicate SBQ) will secure 7250 participants

ESCAPE - Recruitment

ESCAPE - Trial Interventions

Questionnaires returned to research team at UCL

Participants randomly allocated to

Control Group:

standard NHS ‘Giving up for life’ booklet

the usual care offered by general practice

Intervention Group:

computer-tailored feedback report

additional one month assessment and feedback report

ESCAPE – Outcome Measures

6 month follow-up questionnaire

Primary:• prolonged abstinence for 1 and 3 months

Secondary: • 24hr and 7 day point-prevalence abstinence• quit attempts• changes in motivation, intention to quit, cognitions• use of NRT or Zyban• contact with advice services or health professionals

Process:• adherence to advice• perceptions of the feedback reports • perceived personal relevance of feedback

Applications and Future Directions Questionnaire and feedback can structure and

reinforce advice given by health professionals

System can offer an efficient way of integrating smoking cessation counselling into a busy primary care practice

Internet version

Pharmacies

Dental practices

Workplaces

Opticians