Encouraging smokers to seek help to quit: the Start2quit randomised trial to increase attendance at NHS Stop Smoking Services
Support to quit services globally are under-used. Many smokers say they want to quit, but most do not utilise the very effective quit smoking support services available. GPs and health professionals refer smokers to the NHS Stop Smoking Services (SSS), but many do not follow-up their referral and contact the service to make an appointment. The aim of this study was to encourage and motivate more smokers to seek, or accept, help and to use the services provided. We conducted a randomised controlled trial using proactive recruitment strategies to assess the effect of an intervention comprising a brief personal risk letter and an invitation to a no-commitment taster session, compared with a standard generic letter advertising the service, on attendance at the SSS, and on 7-day point-prevalent abstinence 6 months after randomisation.
Eighteen SSSs and 99 general practices were recruited into the trial. Current smokers aged 16 and over, identified from medical records in participating practices, were sent an invitation to take part in the research, together with an assessment questionnaire. All smokers returning the questionnaire, giving consent, and eligible to participate (n=4383) were randomised to the Intervention group to receive a brief computer-tailored risk letter and invitation to attend a taster session (n=2635), or to the Control group to receive a generic letter advertising the local SSS (n=1748). Attendance at the SSS and 7-day point-prevalent abstinence were measured at the 6-month follow-up.
Of the 2,635 individuals in the intervention group invited to the taster session, 739 (28%) attended. Attendance at SSS in the 6 months from randomisation to follow-up was significantly higher in the Intervention than in the Control group (17.4% vs 9.0%, OR 2.12[1.75–2.57], p<0.001). Participants in the intervention group were more than twice as likely to attend all appointments and complete the 6-week SSS course than those in the control group (14.5% vs 7.0%, OR 2.24[1.81–2.78], p<0.001), and 7-day validated point-prevalent abstinence at the 6 month follow-up was also significantly higher in the Intervention group (9.0% vs 5.6%, OR 1.68[1.32–2.15], p<0.001). The effect of the intervention was significantly greater for males than for females, both on attendance at the SSS (OR 2.70 vs OR 1.67) and on validated 7-day point-prevalent abstinence (OR 2.37 vs OR 1.23).
The use of more proactive recruitment methods, personal risk information, and the opportunity to attend a no-commitment taster session can increase attendance at smoking support services. This strategy offers SSSs an opportunity to promote the service, and emphasise its approachability and empathy. That the intervention also translated to increased quit rates demonstrates its potential to increase the success of quit attempts, and subsequently to reduce the burden on primary care.