Development of the Smoking Treatment Optimisation in Pharmacies (STOP) Intervention: Integration of four elements

The problem

Community pharmacies play an important role in NHS stop smoking programmes at primary care level. However recruitment of smokers and service delivery is less than optimal. Improving these services by targeting both increased engagement of smokers and more effective delivery of sessions has potential to improve smoking related outcomes. The STOP study aims to develop a training intervention for community pharmacy workers that directly targets engagement of smokers into the service, and enhances delivery of stop smoking consultations.

The approach

Four elements contributed to intervention development: i) Preliminary qualitative investigations: interview studies were completed to examine perspectives on how individuals were initially engaged, and how stop smoking sessions were delivered with a) pharmacy stop smoking advisors b) client recipients of services. Difficulties encountered and areas for improvement were specifically probed. Conversation analysis of audio-recorded consultations comparing quitters and non-quitters helped to suggest elements of the consultation associated with successful quitting. ii) Systematic Review: a Cochrane review of health promotion interventions within community pharmacies, with specific analysis of the behaviour change techniques and theoretical domains, investigated which theoretical and behaviour change techniques are likely to be effective in the community pharmacy context. iii) Theoretical modelling: analysis of key behaviour change frameworks and theories, suggested potential models for facilitating smoking cessation in community pharmacies. iv) Expert advisory group: input from experts in community pharmacy training and smoking cessation, and from practising pharmacy workers and smoking cessation advisors, guided development of the intervention to ensure face validity.

Findings

Qualitative analysis of interview data suggested that pharmacy workers considered engagement of smokers and delivery of behavioural elements of the stop smoking service to be challenging, and that face to face skills training in these areas would be important. The systematic review supported this and indicated that such an intervention would be novel since pharmacy interventions are typically knowledge based with little application of underlying theory or specific behaviour change techniques. Theoretical modelling suggested an intervention based on Michie's Capabilities Opportunity Motivation -Behaviour (COM-B) framework would be appropriate. This was endorsed by the expert group who augmented the conversation analysis of advisor/client interactions to contribute specific intervention content.The final format of the intervention is a 2x 2 hour training programme for stop smoking pharmacy workers, supplemented by material resources and social media support and documented for future implementation.

Consequences

The intervention has been developed following MRC guidance for complex behaviour change interventions. If the STOP intervention is shown to be effective in the planned randomised controlled trial then there is high potential for rapid roll-out. Since we have used a theoretical and skills based approach much of the content will also be applicable to other behavioural outcomes in a community pharmacy setting.

Credits

• Liz Steed, School of Health Sciences, University of Southampton, Southampton, UK
• Ratna Sohanpal, School of Health Sciences, University of Southampton, Southampton, UK
• Carol Rivas, Centre for Environmental and Preventative Medicine, Queen Mary University of London, London, UK
• Hayden McRobbie, School of Pharmacy, University College London, London, UK
• Rob Horne
• Stephanie Taylor, School of Health Sciences, University of Southampton, Southampton, UK
• Robert Taylor, School of Health Sciences, University of Southampton, Southampton, UK