Presentation by Andy McEwen, Ph.D., National Centre for Smoking Cessation and Training, UK, at the 15th World Conference on Tobacco OR Health in Singapore.

1. Competence-based training for a
national stop smoking service: an English
case study
World Conference on Tobacco or Health
Singapore, Wednesday 21st March 2012
Dr Andy McEwen
NCSCT Executive Director

2. Declarations
Funding
•Funding for the NCSCT is from the English Department of Health (DOH
T336/BSS/M award number 49945)
•Support has also been given by Cancer Research UK and University
College London
Conflict of interest statement
•Andy McEwen undertakes research and consultancy for companies
developing and manufacturing medications to aid smoking cessation and
is on a patent for a novel nicotine inhalation device
Acknowledgements
•NHS Stop Smoking Service practitioners, managers and commissioners
Professor Robert West, Professor Susan Michie, Heather Thomson and
all of the NCSCT staff; particularly Dr Leonie Brose
2

3. 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

4. What do most people think that
smoking cessation involves?

5. What do most people think that
smoking cessation involves?
That we tell people that smoking
is bad for them and that they
should quit

6. The content of behavioural support
Behaviour change interventions are typically complex
with multiple, potentially interacting, components1
Two categories of intervention components2
•Intervention delivery: How it is provided (intervention
provider, 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 Med
2
Davidson et al. (2003) Ann Behav Med

7. 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

8. 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

9. Behaviour change techniques (BCTs)
1. Describe treatment programme
2. Build rapport
3. Describe what behavioural support involves
4. Facilitate and advise on use of social support
5. Describe stop smoking medications
6. Assist smoker to set a quit date
7. Enhance motivation and self-efficacy
8. Emphasise the importance of the not-a-puff rule
9. Secure commitment to the not-a-puff rule
10. Help smoker cope with barriers, cues and triggers
11. Review experience of medication usage
12. Advise on adjustment of medication use
13. Use CO measurement
14. Deal with discrepancies between self-report and CO measures
15. Deal with lapses
16. Assess commitment, readiness and ability to quit

10. NCSCT Training and Assessment
Programme
• 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

11. Stage 1 Online Training and Assessment

12. Evaluation of online knowledge training
and 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
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13. All changes p<0.001
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14. 14

15. 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

16. Not confident Highly confident
80% completed follow-up
Change before-after: p<0.001
Change before-FU: p<0.001
16

17. 17

18. 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
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20. www.ncsct.co.uk
enquiries@ncsct.co.uk
andy.mcewen@ucl.ac.uk