Smoking Treatment Optimisation in NHS Community Pharmacies (STOP): assessment of intervention acceptability, feasibility, and fidelity.

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 an intervention for community pharmacy workers that directly targets engagement of smokers into the service, and enhances the effectiveness of stop smoking consultations. This pilot cluster randomised controlled trial was designed to test the intervention for acceptability and feasibility of implementation within the community pharmacy setting, and to test methods for checking fidelity.

Approach

Community pharmacies and associated stop smoking advisors were allocated to the STOP educational intervention comprising five hours of practical training on client engagement and behaviour change skills split over two evening sessions held a fortnight apart with additional resources for in-practice use (a desk top flip chart) and social media support or to standard practice (allocation ratio 2:1) using simple randomisation. Objectives were firstly to evaluate acceptability of the training intervention via i) data on completion and uptake of training and key intervention elements, ii) qualitative interviews post intervention, and secondly to test fidelity in implementing the intervention in practice using simulated clients. Thematic analysis was applied to interview data and fidelity data was analysed descriptively.

Findings

Eleven smoking advisors from seven intervention pharmacies agreed to attend the two session training programme. Five advisors attended the first session and three completed both sessions. In-pharmacy training was subsequently organised for five further individuals of whom three completed the full training programme. Reasons for non-attendance or drop out, and perceptions of those who took part, will be presented together with findings from the simulated client fidelity assessment.

Consequences

The intervention was highly rated by smoking cessation advisors and delivery was practical in this setting, however changes need to be made to ensure that counter assistants in addition to stop smoking advisors are offered training, particularly in client engagement. Specific issues related to training logistics and implementation of interventions in the community pharmacy setting were identified and are currently being incorporated in the final version of the STOP intervention. The methods for testing fidelity worked well and will be scaled up for the final full scale randomised controlled trial.