6th UK Implementation Science Research Conference
Menu
PRESENter
authors
Biography
Bernadett is a 2nd year PhD student within the Nicotine Research Group in the Addictions Department at King’s College London. She is supervised by Dr Leonie Brose and Professor Ann McNeill.
PhD thesis provisional title: Improving the provision and uptake of smoking cessation treatment in the United Kingdom.
Overarching aim of her PhD is to investigate how smoking cessation treatment provision in the UK could be improved, and to explore how prescription e-cigarettes may help to do this, to further reduce the prevalence of smoking and meet the smoke-free 2030 target (adult smoking prevalence to be 5% or less in England).
Bernadett’s PhD funding: 1+3 (Masters + PhD) Economic and Social Research Council (ESRC) London Interdisciplinary Social Science Doctoral Training Partnership (LISS DTP).
Qualifications:
• Medicine, Health and Public Policy MSc (King’s College London) 2019-2020
• Biomedical Science BSc (Imperial College London) 2012-2015
background
Controlled trials have found some evidence for the efficacy of interventions aiming to increase the provision of smoking cessation treatment in primary care settings [1], but we need ‘real-world’ evidence, where implementation strategies [2] are implemented without researcher input. Aim: To identify ‘real-world’ implementation, effectiveness and cost-effectiveness of implementation strategies aiming to increase smoking cessation treatment provision in primary care, and any perceived facilitators and barriers for effectiveness.
MEthod
Seven databases, and three grey literature sources were searched from inception to April 2021. Studies were included if they evaluated implementation on a national or state-wide scale, contained practitioner performance and patient smoking outcome measures. Studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was conducted using the ERIC compilation [3,4] and CFIR [5].
results
Of 49 included papers, half were of moderate/low risk of bias. The implementation strategies identified involved utilising financial strategies, changing infrastructure, training and educating stakeholders, and engaging consumers. The first three strategies increased the provision of cessation advice in primary care but no intervention had high-quality evidence of impact on patient smoking cessation. No studies assessed cost-effectiveness. External policies/incentives (wider tobacco control measures and funding for public health and cessation clinics) were key facilitators. Time and financial constraints, lack of free cessation medications and follow-up, deprioritisation and unclear targets in primary care, lack of knowledge of healthcare professionals, and unclear messaging to patients about cessation were key barriers.
Conclusion
Some implementation strategies increased the rate of delivery of cessation advice in primary care, but there was no high-quality evidence showing an increase in quit attempts or smoking cessation. Barriers to effectiveness identified in this review should be reduced. More pragmatic approaches are recommended, such as ‘hybrid effectiveness-implementation designs’, and ‘Multiphase Optimization Strategy’ (MOST) [6].
Trial Registration PROSPERO: CRD42021246683
References:
1. Lindson N, Pritchard G, Hong B, Fanshawe TR, Pipe A, Papadakis S. Strategies to improve smoking cessation rates in primary care. Cochrane Database of Systematic Reviews. 2021 Sep 6;2021(9).
2. Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implementation Science. 2013;8(1):139.
3. Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implementation Science. 2015;10(1):109.
4. Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science. 2015;10(1):21.
5. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug;4:50.
6. Collins LM, Baker TB, Mermelstein RJ, Piper ME, Jorenby DE, Smith SS, et al. The multiphase optimization strategy for engineering effective tobacco use interventions. Ann Behav Med. 2011 Apr;41(2):208–26.