Determining counselling communication strategies associated with successful quits in the National Health Service community pharmacy Stop Smoking programme in East London: a focused ethnography using recorded consultations

Abstract

ObjectivesTo determine communication strategies associated with smoking cessation in the National Health Service community pharmacy Stop Smoking programme.Setting11 community pharmacies in three inner east London boroughs.Participants9 stop smoking advisers and 16 pairs of smokers who either quit or did not quit at 4 weeks, matched on gender, ethnicity, age and smoking intensity.Method1–3 audio-recorded consultations between an adviser and each pair member over 5–6 weeks were analysed using a mixed-method approach. First a content analysis was based on deductive coding drawn from a theme-oriented discourse analysis approach and the Roter Interaction Analysis System. Core themes were identified through this quantification to explore in detail the qualitative differences and similarities between quitters and non-quitters.ResultsQuantitative analysis revealed advisers used a core set of counselling strategies that privileged the ‘voice of medicine’ and often omitted explicit motivational interviewing. Smokers tended to quit when these core strategies were augmented by supportive talk, clear permission for smokers to seek additional support from the adviser between consultations, encouragement for smokers to use willpower. The thematic analysis highlighted the choices made by advisers as to which strategies to adopt and the impacts on smokers. The first theme ‘Negotiating the smoker–adviser relationship’ referred to adviser judgements about the likelihood the smoker would quit. The second theme, ‘Roles of the adviser and smoker in the quit attempt’, focused on advisers’ counselling strategies, while the third theme, ‘Smoker and adviser misalignment on reasons for smoking, relapsing and quitting’, concerned inconsistencies in the implementation of National Centre for Smoking Cessation and Training recommendations.DiscussionAdvisers in community pharmacies should use the advantages of their familiarity with smokers to ensure appropriate delivery of patient-centred counselling strategies and reflect on the impact on their counselling of early judgements of smoker success.

The utility of Conversation Analysis versus Roter’s Interaction Analysis System for studying communication in pharmacy settings: a scoping review

“…[33,34,36,37] Data collection time was mentioned in most RIAS studies. [33,35,[38][39][40][41][42][43] The similarities and differences between the two methods were identified in terms of their topic of focus, methodology, main findings and future recommendations. A comparison between RIAS and CA studies is thus outlined in Table 1.…”

STOP— a training intervention to optimise treatment for smoking cessation in community pharmacies: cluster randomised controlled trial

“…The Smoking Treatment Optimisation in Pharmacies (STOP) programme aimed to develop an intervention to increase throughput in the stop smoking services in community pharmacies and to improve quit rates by providing training including motivational interviewing and communication skills to pharmacy staff (STOP intervention) [ 17 ]. We conducted extensive qualitative research with both pharmacy staff and users of stop smoking services [ 14 , 18 ], and took into account the factors associated with successful quit attempts and successful outcomes in other behavioural interventions [ 19 , 20 ]. We incorporated the findings from research into communication strategies used in community pharmacies that were associated with successful quitting [ 20 ] and grounded the intervention in social cognitive theory [ 21 ] using validated behaviour change techniques [ 22 ].…”

“…We conducted extensive qualitative research with both pharmacy staff and users of stop smoking services [ 14 , 18 ], and took into account the factors associated with successful quit attempts and successful outcomes in other behavioural interventions [ 19 , 20 ]. We incorporated the findings from research into communication strategies used in community pharmacies that were associated with successful quitting [ 20 ] and grounded the intervention in social cognitive theory [ 21 ] using validated behaviour change techniques [ 22 ]. We piloted the intervention [ 23 ] and refined it based on feedback from pharmacy workers and treated smokers [ 24 ].…”

Evaluating the effectiveness and cost-effectiveness of the Smoking Treatment Optimisation in Pharmacies (STOP) intervention: protocol for a cluster randomised controlled trial

“…However, the number of people using NHS Stop Smoking Services in community pharmacies has declined in recent years [6, 7] and there is evidence to suggest that participating pharmacies may target only smokers perceived as likely to quit [4, 7]. Retention of smokers within the service is poor, with about one-third of those setting a quit date being lost to follow up [4, 8].…”

“…Detailed descriptions of the development of the STOP intervention, including strategies to achieve the intended aims [4, 8, 10], acceptability and feasibility [17], and methods for assessing intervention fidelity are published elsewhere [18].…”