Fabiana Lorencatto Research Associate, National Centre for Smoking Cessation and Training (NCSCT) and University College London
Abstract
Background: NHS Stop Smoking Services (SSSs) have treatment manuals to guide practitioner behaviour, drawing on evidence of effective behavioural support. To assess implementation of recommended practice (‘fidelity’), we need methods for assessing whether recommended practice is actually delivered.
Objectives: To develop methods for assessing fidelity of delivery of behavioural support, including the quality of a key technique, setting a quit date (i.e.’goal setting’).
Methods: Treatment manuals and 84 transcripts of audio-recorded sessions obtained from two SSSs and a national Quitline were coded into BCTs using an established taxonomy of 44 BCTs. Discrepancies between BCTs in treatment manuals and delivered in sessions were assessed. For 104 transcripts of pre-quit sessions from the Quitline, a scale for scoring optimal delivery of setting a quit date was developed, guided by manuals and national guidance documents. Maximum score was 7, with points deducted for incomplete or inappropriate delivery. Inter-rater reliability was assessed.
Results: On average, only 48% (SD 4.5) of BCTs in treatment manuals were delivered in practice. In sessions discussing a quit date, average quality score for its delivery was low: 1.5 (range:-1 to 6). Reliability for assessing fidelity and quality was high (78.8% agreement/kappa=0.79, respectively). Higher quality of goal setting was significantly associated with increased likelihood of clients quitting as planned on the quit date (p=0.03; OR 1.5, 95%CI:1.03-2.22).
Conclusions: It is possible to reliably assess fidelity and quality of delivery of behavioural support. Overall fidelity and quality of setting a quit date appear to be low in the services studied, highlighting targets for training and manual improvement.
Source of funding: National Centre for Smoking Cessation and Training (Department of Health Grant DOH T336/ BSS/M award number 49945)
Declaration of interest: Fabiana Lorencatto has received travel funds and hospitality from Pfizer, which manufactures Champix.
Robert West has undertaken research and consultancy for companies that develop and manufacture smoking cessa- tion medications. Robert West has a share of a patent in a novel nicotine delivery device.
