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E of computer-tailored S moking C essation A dvice in P rimary car E A Randomised Controlled Trial

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E of computer-tailored S moking C essation A dvice in P rimary car E A Randomised Controlled Trial. ffectiveness. Hazel Gilbert Department of Primary Care and Population Sciences UCL . Smoking Cessation Interventions. Clinical approach Intensive face-to-face Relatively high quit rates

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Eof computer-tailoredSmokingCessationAdviceinPrimarycarE

A Randomised Controlled Trial


Hazel Gilbert

Department of Primary Care and Population Sciences



Smoking Cessation Interventions

  • Clinical approach
  • Intensive face-to-face
  • Relatively high quit rates
  • Low participation rates
  • Unrepresentative
  • Public health campaigns
      • Large-scale programs
      • Impersonal
      • High reach
      • Low quit rates

NHS Smoking Cessation Service

Longer term data collected from two PCTs

Oct 2001 to March 2003

      • 4 week abstinence 53%
      • 52 week abstinence 15%
      • consistent with published studies
  • Low participation rates
    • 6% of smokers use the services per year
    • 1% of smokers are helped to stop long-term

Challenges for Primary Care

  • To increase success rates in clinics
  • Reach the smokers who do not use clinics
self help materials
Self-help Materials
  • Generic leaflets and manuals
  • Personalised generic
  • Targeted materials to particular groups
  • Individually Tailored Feedback

Definition: ‘intended to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment’

(Kreuter et al 1999)



  • Contact individuals directly offering a service
  • Higher participation
  • More demographically representative

Escape trial is proactively recruiting smokers by sending questionnaires to a large population group using GP records


Tailored feedback+Proactive Recruitment

behavioural intervention principles of the clinical approach

participation rates of public health campaigns

provide personal, individually tailored self-help reports for a large population of smokers


Targeting specific population groups

    • Smokers not motivated to quit
    • Areas of high deprivation where smoking prevalence is higher
  • Primary Care Networks can help us to target these specific population groups and achieve the objectives

Practice Recruitment

  • Aimed to recruit 100 MRC GPRF practices, representing high and low socio-economic areas
  • 116 expressed an interest in the study
  • Ranked practice postcodes from least to most deprived by Carstairs scores
  • Allocated to deprivation quintiles
  • Selected proportionally from each quintile

Participant Recruitment

  • Practices identify current cigarette smokers aged 18 to 65 from records using the computer system
  • Randomly select a sample of 520
  • List screened by GP to exclude patients not appropriate e.g. terminal illness
  • Smokers (n=50,000) sent the Smoking Behaviour Questionnaire together with a covering letter from GP

Estimate a response rate of 15% from 2 mailings (reminder and duplicate SBQ) to secure 7250 participants







Professor Irwin Nazareth

Dr Richard Morris

Department of Primary Care and Population Sciences, UCL

Professor Stephen Sutton

Institute of Public Health, University of Cambridge

Professor Christine Godfrey

Department of Health Sciences, University of York



To examine the effect of computer generated individually tailored feedback reports designed to help and encourage smokers to quit, on quit rates and quitting activity, when sent to smokers with varying levels of motivation and reading ability, identified from GP lists


The Trial Interventions

  • Participants return the questionnaire to the research team at UCL. Randomly allocated to either:

Control Group

        • Standard booklet
        • Usual care offered by the practice
  • Intervention Group
        • Standard booklet
        • Usual care offered by general practice
        • Computer-tailored feedback report
        • Additional assessment and feedback report one month after baseline received

Smoking status, cognitive change, adherence to advice, perceptions of the feedback reports, and economic issues assessed by postal questionnaire at a 6-month follow-up


Expected outcomes

  • Simple and inexpensive intervention 
  • Low-cost, high-reach approach that can complement and extend the brief advice given by GPs
  • Enable the standardised collection of relevant information by practice nurses or other health professionals, and can be used to structure and reinforce the advice given
  • Could offer an efficient tool to integrate smoking cessation counselling into a busy primary care practice

Why do we need research into smoking cessation?

  • Leading preventable cause of disease and death
  • Smoking is a modifiable behaviour
  • Approximately 25% of the population still smoke