Competence-Based Training for a National Stop-Smoking Service: An English Case Study -- Andy McEwen, Ph.D.
Competence-based training for anational stop smoking service: an Englishcase studyWorld Conference on Tobacco or HealthSingapore, Wednesday 21st March 2012Dr Andy McEwenNCSCT Executive Director
DeclarationsFunding•Funding for the NCSCT is from the English Department of Health (DOHT336/BSS/M award number 49945)•Support has also been given by Cancer Research UK and UniversityCollege LondonConflict of interest statement•Andy McEwen undertakes research and consultancy for companiesdeveloping and manufacturing medications to aid smoking cessation andis on a patent for a novel nicotine inhalation deviceAcknowledgements•NHS Stop Smoking Service practitioners, managers and commissionersProfessor Robert West, Professor Susan Michie, Heather Thomson andall of the NCSCT staff; particularly Dr Leonie Brose 2
Context• The United Kingdom of Great Britain and Northern Ireland• NHS Stop Smoking Services provide behavioural support and access to medication (free or for a small charge)• Behavioural support provided by Specialist and Community stop smoking practitioners• Treated 800,000 smokers last year, have treated 1,000,000+ smokers in past 10 years• We do not have a National Stop Smoking Service: 150 local commissioning groups covering an average population of about 60,000 smokers. Huge variation in throughput and success rates 3
What do most people think thatsmoking cessation involves?
What do most people think thatsmoking cessation involves?That we tell people that smokingis bad for them and that theyshould quit
The content of behavioural supportBehaviour change interventions are typically complexwith multiple, potentially interacting, components1Two categories of intervention components2•Intervention delivery: How it is provided (interventionprovider, format, setting, recipient, intensity, duration,fidelity)•Intervention programme: What is delivered(component behaviour change techniques (BCTs) -active ingredients)1 Michie, Churchill & West (2011). Ann Behav Med2 Davidson et al. (2003) Ann Behav Med
Taxonomy of smoking cessation BCTs• 43 BCTs, extended to 53 competences (knowledge and skills)• Clear, consistent descriptions, labels and terminology• Address four behaviour change functions: • Boosting motivation • Maximising self-regulatory capacity and skills • Adjuvant activities • General aspects of the role/interaction
Applications of the taxonomy• Coded NHS SSS protocols and published descriptions of effective behavioural support interventions; identified evidence-based BCTs for generic individual- and group- behavioural support1• Coded SSS protocols and descriptions of effective interventions to identify evidence-based BCTs for pregnant smokers and mental health 2• Coded SSS protocols and looked at association with outcomes using logistic regression. Identified 16 BCTs significantly associated with improved CO-validated 4- week quit outcomes 3 1 Michie, Churchill & West (2011). Ann Behav Med 2 Lorencatto et al. (In preparation) 3 West et al. (2010) Nic Tob Res
Behaviour change techniques (BCTs)1. Describe treatment programme2. Build rapport3. Describe what behavioural support involves4. Facilitate and advise on use of social support5. Describe stop smoking medications6. Assist smoker to set a quit date7. Enhance motivation and self-efficacy8. Emphasise the importance of the not-a-puff rule9. Secure commitment to the not-a-puff rule10. Help smoker cope with barriers, cues and triggers11. Review experience of medication usage12. Advise on adjustment of medication use13. Use CO measurement14. Deal with discrepancies between self-report and CO measures15. Deal with lapses16. Assess commitment, readiness and ability to quit
NCSCT Training and AssessmentProgramme• Online training to deliver knowledge-based competences, with knowledge (Stage 1) and skills (Stage 2) assessments• To supplement local training, face-to-face courses (two days) in behavioural support offered to selected services 10
Evaluation of online knowledge trainingand assessment programme• Data from first year: Sept 2010 - Sept 2011• Change in knowledge from before to after training• 5,510 unique trainees registered• 2,289 UK stop smoking practitioners• 1,540 completed both assessments 12
Evaluation face-to-face training• Trainees’ confidence in their own competences to deliver effective stop smoking support• Additional question responses at follow-up• 719 trainees in 28 courses• 21 courses with follow-up data (N=569) 15
Conclusion• The evidence-based NCSCT training improves knowledge and confidence in skills to deliver effective stop smoking support• Next step to investigate association with success rates and actual skills 18