Does inducing fear using personal risk factors to prompt smokers to quit?

Problem

Many smokers say they want to quit but programmes of support are consistently under-used and clinical interventions reach relatively few, self-selected smokers. We conducted a randomized controlled trial to persuade and motivate more smokers to seek or accept help to quit. The Start2quit trial assessed the effectiveness of a brief personal risk letter and invitation to a no-commitment taster session on attendance at the NHS Stop Smoking Services (SSS), compared to a standard generic letter advertising the SSS. There is a risk that personal risk information could induce too much fear or create hostility. To ensure that the risk letter was acceptable and did not prompt a maladaptive response, we explored the perceptions and acceptability of the intervention.

Approach

Smokers participating in the Start2quit randomised controlled trial (n=4383) were randomised to the intervention group to receive a personal risk letter with an invitation to a taster session run by the SSS, or to the control group to receive a generic letter advertising the SSS. The personal risk letter used information from medical records and from the baseline assessment questionnaire to enhance the personal relevance of the information. Perceptions of the letter and of the taster session were assessed in a telephone interview at the 6-month follow-up.

Findings

Those who received the tailored letter were not more likely to remember receiving a letter, but were more likely to read it (96.7% vs 94%, p=0.004), and to discuss it with others (43.2% vs 35.7%, p<0.001). They found it to be more personally relevant, and reported that it made them feel more confident and determined towards quitting, compared to those who received the standard letter (p<.001). Few reported it causing them to be angry (4.1%), depressed (4.5%) or anxious (8.2%), and 67% felt at least moderately optimistic. The taster sessions were seen as helpful and reassuring by those who attended, and built the intended awareness and comfort with the services. Of those who received the intervention and attended the SSS, over 70% reported that the taster session and the letter were equally important in their decision to attend.

Consequences

Participants found the tailored personal risk letter acceptable, and few were upset by it, indicating that the balance between anxiety and reassurance was appropriate. The taster session was well-received. While it seems that both parts of the intervention worked in concert to increase attendance, the complexity and interaction between the two components of this intervention make it difficult to determine which component is the most essential. More research is needed to dismantle the components.