Lorencatto, F;
(2013)
Translating evidence into practice:Behavioural support for smoking cessation.
Doctoral thesis (PhD), UCL (University College London).
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Abstract
Background: Evidence-based behaviour change interventions are increasingly implemented in wider clinical practice, such as smoking cessation behavioural support interventions (BSIs) delivered via the English NHS Stop Smoking Services (SSSs). However, the process of translating evidence into practice is complex, slow and often unpredictable. Aims: This thesis investigated factors related to the translation of evidence into practice for smoking cessation BSIs, including: specification and reporting of intervention components, fidelity and quality of delivery, and associations between implementation and outcome. Methods: Six mixed-methods studies were conducted using BSIs delivered by the NHS SSSs as a case study for examining implementation. In Study 1, a taxonomy of smoking cessation behaviour change techniques (BCTs) was applied to specify components comprising effective BSIs for pregnant smokers. Study 2 applied the taxonomy to assess the current standard of published reporting of the content of BSIs. Study 3 assessed the reliability of the taxonomy as a framework for specifying BCTs in transcripts of audio-recorded behavioural support sessions. Studies 4 and 5 applied the taxonomy to assess the extent to which manual-specified BCTs are delivered in practice (i.e. fidelity). Study 6 developed a 10-point scale for rating quality of delivery of a key BCT ‘goal-setting,’ and examined whether quality was associated with smokers’ enactment of planned quit attempts (i.e. outcome). Results: The taxonomy demonstrated consistently high reliability for coding into component BCTs the content of BCIs as described in published reports, trial protocols, service treatment manuals and session transcripts, (Studies 1-5). Using this method, 11 evidence-based BCTs for smoking cessation in pregnancy were specified (Study 1). Published reports of BSIs were inadequate, omitting on average 50% of intervention content originally specified in trial protocols (Study 2). Fidelity was found to be consistently low, with typically less than 50% of manual-specified content being delivered (Studies 4 and 5). It was possible to reliably assess quality of ‘goal-setting,’ which on average was low; however, higher quality of goal-setting significantly increased the likelihood of smokers enacting planned quit attempts (Study 6). Conclusions: Translation of evidence into practice for smoking cessation BSIs is not uniform, with information loss occurring as interventions are disseminated and delivered in practice. The taxonomy provides a reliable methodological approach for examining factors related to implementation. Observed translational issues may inform future training and interventions to improve implementation of BSIs in clinical practice.
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