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A realistic evaluation of an open access stop smoking clinic
Jane Beach
Abstract
The UK has a network of smoking cessation clinics, typically, providing group based support lasting an hour per week over seven consecutive weeks. Around 70% of participants are quit at the end of the course; but groups have a limited population reach. In March 2004 South Birmingham Stop Smoking Service developed an alternative model of service in the form of an open access Drop In clinic. Instead of struggling to fill groups, smokers were queuing out of the door. The stop smoking advisors provided carbon monoxide monitoring, advice, lasting typically 5 minutes, and one weeks supply of NRT, free. Participants were followed up for four weeks and more than half remained quit. The Drop In proved a popular format in comparison to groups. This qualitative study used a realistic evaluation model, to examine why.
A focus group with six stop smoking advisors and interviews with eleven participants identified the mechanisms and contexts of the clinic considered to be involved in enabling smokers to change their behaviour. The principles of grounded theory were used to formulate Context, Mechanism, Outcome (CMO) configurations, which provided propositions stating what it was about the clinic that worked, for whom and in what circumstances.
Ten CMO configurations were identified. Two of the most important being: One Stop Shop and Innovative Service. It was considered that as many people live life at a fast pace, the streamlined service provided suited those who subscribed to this ethos, which facilitated them to attend and subsequently quit. Furthermore, the PCT had a target for the number of smokers it was expected to support and required a large throughput of people. Therefore, service developments were encouraged and funded. The innovative nature of the clinic attracted large numbers into treatment, many of who quit, boosting the target.
This study suggests that in order to attract smokers and facilitate them to quit, services need to be configured that are convenient, innovative, supportive and include free NRT. The importance of working in partnership with primary health care was also highlighted as an effective way of increasing throughput, whilst maintaining quality.
Biography
Jane Beach is a trained nurse, midwife and health visitor. In 2001 she obtained a BSc(Hons) in Health Studies and went on to successfully complete her Masters in Public Health in 2005.
She worked as a health visitor for 15 years, during which time she developed an interest in smoking cessation and moved into the stop smoking service in 2002 first as the young people's adviser and now as the Clinical Lead. She has an interest in smoking cessation research and is a member of SRNT.
Author 1: Jane Beach
Stop Smoking Specialist Clinical Lead
Springfield Centre
Raddlebarn Road
Selly Oak
Birmingham
B29 6JB
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