Are smoking cessation behavioural support interventions delivered as intended? Assessing fidelity of delivery in NHS stop smoking services
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Author(s)
Fabiana Lorencatto, Robert West and Susan Michie
Presenter(s)
Fabiana Lorencatto Research Associate, National Centre for Smoking Cessation and Training (NCSCT)
Abstract
Background
Behavioural support interventions are widely delivered in practice by the UK NHS Stop Smoking Services (SSSs). We lack methods for assessing the extent to which they are delivered as intended, with fidelity to protocol. This study aimed to: i) develop methods for assessing fidelity; ii) examine fidelity of behavioural support delivered by two SSSs.
Methods
Treatment protocols and transcripts of 34 audio-recorded consultations were obtained from two SSSs and coded into behaviour change techniques (BCTs) using a taxonomy of 44 BCTs. Fidelity was assessed by comparing discrepancies between BCTs identified in protocols and consultations. Fidelity was assessed for each SSSs overall, by session type (pre-quit/quit/post-quit), and practitioner. Inter-rater reliability was assessed.
Results
Coding reliability was high (80.9%). Protocols comprised on average 24 BCTs. On average, consultations contained 22 BCTs (Range:4-27), of which 50.98% were BCTs also identified in protocols. BCTs identified in protocols delivered frequently in consultations (high fidelity) included: ‘build rapport’ and ‘review of goals (95.24% of consultations).’ Those delivered infrequently included: ‘goal-setting’ and ‘prompt self-recording’ (14.29%). Fidelity did not differ significantly by practitioner or session type.
Discussion
It is possible to reliably assess fidelity of behavioural support. Practitioner fidelity in these services appears to be poor. This BCT analysis informs an understanding of variance in intervention outcomes and practitioner training needs.
Source of funding: National Centre for Smoking Cessation and Training. Supported by English Department of Health.
Declaration of interest: Fabiana Lorencatto has received travel funds and hospitality from Pfizer, who manufacture Champix. Robert West has undertaken research and consultancy for companies that develop and manufacture smoking cessation medications. Robert West has a share of a patent in a novel nicotine delivery device. Susan Michie has received travel funds and hospitality from Pfizer, who manufacture Champix. She has received fees for speaking at educational events sponsored by Pfizer. She has received research funds and consultancy payments from the Department of Health and the Department of Transport.
