QUIT UK-Wide Cessation Services

1. QUIT UK-WideCessation Services A comprehensive approach

2. A truly UK-Wide Service • We operate United Kingdom wide • Unlike state-run services that have to comply to national (akin to state/province) boundaries, we span like a federal initiative. • England, Scotland, Wales and Northern Ireland

3. Challenges at design stage • Identify the target smokers and their social and psychological characteristics to identify their needs • Determine how our communication (promotional included) and service delivery strategies will meet their needs • Create a service and communication strategy that bridges their needs and our services. Create an “OFFER” that is clinical and cost effective and yet remaining culturally and linguistically sensitive

4. Social factors considered in the offer- service and communication • Age • Gender • Marital/Parental status (single, lone parent) • Socio-economic status (poverty and deprivation) • Mental health • Ethnicity • Health inequality

5. Psychological factors considered in the offer- service and communication • Cognitive and Intellectual: • Knowledge • Perception • Beliefs • Motivational (affective and emotional elements): • Needs • Emotions • Attitudes

6. Bridging and touching • Help the smoker identify and touch with the unsatisfied need- I need and want to become smoke free! • Bridge the gap-need and services by communicating the main elements of our offer- the Quit service will help me

7. The communication strategy (1) • Impersonal mass communication- broadcast and print • Personal mass media- the community events, lectures, outreach work and Melas • Impersonal individual communication- A5 flyers, leaflets, direct mail standard letters • Personal Individual direct media- Tailored letters, personalised Quit plans and one-2-one outreach clinics

8. The hybrids (2) • Information and Computer Technologies can enhance and take a communication and service provision to new heights • The converged Quitline, WebSite, E-mail, SMS Text Service can be both a impersonal/personal mass media and Impersonal/personal individual media • The smoker gets self help from a website, motivation from a Quitline, support via SMS and one-2-one at a local clinic

9. Our Brand! • An appropriate helping/communication style • We put the client first • Client centred and inclusive approach • No finger wagging- culturally and linguistically sensitive • Comprehensive approach

10. Communication styles Excludes the client MANIPULATING TELLING Problem Centred Client Centred ADVISING COUNSELLING Includes the client

11. Elements of the offer (1) • It is for you- it matches you. Youth to Youth Services, Pregnant Women to Pregnancy Services and Language lines for others • Opening hours to suit you- 9am-9m (after hours) • Staff match you- youth worker and midwife • Staff training selected and matched to your needs- counselling to pre/neonatal experience • A professionally accredited service

12. Elements of the offer (2) • It is a normal and fashionable thing to do to become a non-smoker • You have from your armchair (ease of access) access to: • Highly trained and qualified professional smoking cessation counsellors (note: not agents or advisers as call centres!) • You will get comprehensive and free counselling and other support- if we can’t help you, we know of friends who can (sign posting) • You are accessing services that suit you- we can give you a choice menu

13. Your access to evidence-based services • We adopted the National Guidelines • International evidence base: • European Network of Quitlines Best Practice Guide incorporating evidence from 12 EU Countries • North American: Zhu, S.H. (2002) Evidence of Real-World Effectiveness of a Telephone Quitline for Smokers,New England Journal of Medicine, 347:1087-1093 14 • Australian Guidelines

14. Clinical Governance--Guidelines • Published in 2000 and apply to all smoking cessation treatments. NICE endorsed them. • Full Title: Smoking Cessation Guidelines for Health Professionals –an update West, McNeill and Raw Thorax ; 55:987-999 (2000) • Recommends that a smoker who is committed and motivated to quit (at the right stage of change) must be offered: • Intense behavioural support to manage the psychological, emotional and automatic dependencies • NRT or Zyban to manage the chemical dependencies

15. Other points • We offer smoking cessation advice on treatments, behavioural and pharmacotherapies (NRT/Zyban), whose clinical and cost effectiveness has been evaluated • We measured smokers remaining smoke free for 6 months or more as per guidelines--use gold standard at 12 months • Our public health approach in providing smoking cessation treatments is systemic and systematic

16. 1st Tier Service--Quitlines • First line of service provision are the Quitlines- • General Quitline • Dads Quitline • Pregnancy Quitline • Lone Parent Quitline (intermitent in support of campaigns) • 9 Ethnic Language Quitlines • Heart Line and Health Mot Quitlines

17. Why use Quitlines? • A clinically and cost effective PUBLIC HEALTH intervention (large outreach and very suitable for media campaigns): • Owen L (2000) Impact of a telephone helpline for smokers who called during a mass media campaignTobacco Control 2000;9:148-154 • European Network of Quitlines Best Practice Guide European Network of Quitlines 2003 • North American: Zhu, S.H. (2002) Evidence of Real-World Effectiveness of a Telephone Quitline for Smokers,New England Journal of Medicine, 347:1087-1093 14 • Address Health Inequality- Cheap (Toll Free)

18. 2nd Tier Service—Self Help • Providing a comprehensive, evidence based and evaluated smoking cessation resources and self help material. Made it relevant to each class or group as per guidelines: • Generally: 15 Titles on smoking cessation- behavioural support, NRT, Myths, • Youth: 8 Titles and teacher’s pack • Ethnic Minorities: In 12 languages • Health professional training resources

19. 3rd Tier--The Outreach Clinic (Hard to Reach Groups) • Provide comprehensive on-site health checks: The Health Mot • Every year we set the clinic up in a community fair • Provide Healthy Lifestyles Advice to smokers • Measure Blood Pressure, Cholesterol, Glucose, BMI, CO and other factors

20. 4th Tier--PCT Stop Smoking Clinics • Managing stop smoking services for the Primary Care Trusts • Set up under “Smoking Kills” initiative in 1998 • Based in spearhead high deprivation areas • Offering intensive support on one-to-one and groups • Kensington and Chelsea service offers proactive Quitlines along side one-2-one

21. 5th Tier--The Specialist Lines • Quitlines on NRT products • Quitlines on special campaigns– Smoke-Free Ramadan • Quitlines on specific smoking and health related area-- Heart Line

22. Quitline Results

23. Quitline Quit rates • University of Cambridge Research 2003 on UK Quitline* • After a campaign, 12.14% of smokers remained abstinent for more than three months at 6month follow up • 9.4% had remained abstinent for more than 6months Telephone helplines: Are they a Useful Public Health Intevention for Smoking Cessation (2003) Gilbert H and Sutton S Institute of Public Health Cambridge

24. Who Calls Quitlines • Compared to stop smoking clinics, more female callers call the Quitlines • Main callers in 25-34 age group • A majority of the callers started smoking when under 16 • Dependence level higher in Quitline users than in the clinics Who calls Quitlines? The Characterristics of smokers seeking advice via telephone helplines. (2003) Gilbert H and Sutton S Institute of Public Health Cambridge

25. Individualised support on Quitlines • Tailored feedback, support material and other communication was more effective than general material- up to 25% more likely to quit when compared to general material • Proactive counselling and support that was individualised was up to 31% more likely to work than standard reactive approaches • Programmes tailor made to youth had more quit attempts than general stop smoking programmes