1. Evaluation of the two-stage training programme for stop smoking practitioners provided by the NHS Centre for Smoking Cessation and Training (NCSCT)

Principal Investigators: Dr Andy McEwen, Professor Robert West, Professor Susan Michie, University College London

Research Associate: Dr Leonie Brose

Funded by the Department of Health, UK.

Background: The NCSCT was commissioned by the Department of Health to identify the competences required to deliver, manage and commission smoking cessation support in England, to develop and implement methods of assessment to ensure that stop smoking practitioners, managers and commissioners possess these competences and to commission and provide training and continuing support to allow staff to achieve the required level of competence. The NCSCT provides a two-stage training to practitioners; the first stage is an online training and assessment programme to deliver knowledge-based competences, the second stage focuses on skills-based competences and is delivered as face-to-face courses.

Aim: To validate the knowledge assessment used in Stage 1 of the training and to evaluate the training programme in terms of acceptability, impact on knowledge and on confidence in competences required to deliver effective interventions.

Methods: Analysis of change in knowledge during Stage 1 of the training, assessed using multiple choice questions. Validation of knowledge assessment using free-text responses to knowledge questions. Analysis of practitioners’ confidence in their competence to deliver effective interventions before and after Stage 2 of the training. Tracking trainees’ evaluation of the training programme.

2. Factors associated with success of NHS stop smoking services

Principal Investigator: Professor Robert West, University College London

Research Associate: Dr Leonie Brose

Funded by Cancer Research UK.

Background: The English network of stop smoking services are among the National Health Service’s best-value life-preserving clinical interventions and are internationally renowned. However, success varies considerably across services.

Aims: To examine factors that influence the effectiveness of stop smoking service interventions and to determine what constitutes the most effective treatment.

Methods: Stop smoking services record data on client and intervention characteristics and outcome of treatment; over 30 services using a particular software to record their data have agreed to share anonymised data for research purposes. Complex sample procedures are used to analyse association of characteristics of the intervention with outcome whilst adjusting for client characteristics.

3. Annual surveys of commissioners, managers and practitioners of NHS Stop Smoking Services in England

Principal Investigators: Dr Andy McEwen, Professor Robert West, Professor Susan Michie, University College London

Research Associate: Dr Máirtín McDermott

Background: In 2009, the NCSCT conducted the first of a planned series of annual surveys. This survey served primarily to assess the self-reported training needs of practitioners, managers and commissioners, but also collected data on these professionals’ self-reported activities, attitudes towards smoking and smoking cessation as well as demographic and professional characteristics.

Aim: To provide a snapshot of activities and attitudes of commissioners, managers and practitioners for 2010 and to compare findings between surveys.

4. Development and evaluation of an interactive, internet-based smoking cessation intervention (the ISCI Trial)

Principal Investigators: Professor Robert West, Professor Susan Michie, University College London

Researchers: Dr Jamie Brown, Dr Benjamin Gardner Sood, Andy McEwen, Dr Lion Shahab, John Stapleton, Department of Epidemiology and Public Health, University College London; Sascha Miller, Dr Judy Joseph, Professor Lucy Yardley, University of Southampton

Funded by the Medical Research Council under the National Prevention Research Initiative.

Background: Internet-based interventions can help smokers to stop compared with brief written materials or not intervention. However, they are not widely used in most countries, particularly by more economically disadvantaged  smokers. Moreover, there is significant variation in effectiveness of those evaluated thus far. There is a need for a generally available internet-based smoking cessation intervention in the UK that will be attractive across the social spectrum and of proven effectiveness.

Aim: To develop an internet-based cessation intervention, which has particular appeal to disadvantaged smokers, and determine its efficacy.

Methods: Using open-source intervention software, we will develop and pilot a highly interactice website, informed by a broad motivational (PRIME), empirical evidence from smoking research and experience derived from website design. We will engage disadvantaged smokers in usability testing and qualitative feedback studies, before evaluating the intervention in a randomized controlled trial with at least 4,000 UK smokers, approximately half from disadvantaged groups and half from the general population. The control internet site will present simple advice and information on smoking cessation. The primary outcome measure will be self-report of at least 6 months continuous abstinence, which will be verified by expired air CO or salva cotinine.

5. Behavioural support for smoking cessation in practice

Doctoral Researcher: Fabiana Lorencatto

Supervisors: Professor Susan Michie, Professor Robert West, University College London

Funded by the NHS Centre for Smoking Cessation and Training, and the Department of Health.

Background: Behavioural support interventions are effective in successfully helping smokers to quit. However, there is substantial heterogeneity in quit outcomes across individual research trials and NHS stop smoking services which may in part be attributable to variation in the content of support provided. Due to the complexity and poor reporting of behavioural support interventions, the component behaviour change techniques forming the content of these interventions, and those contributing to quit outcomes, remain unclear. The quality and fidelity of delivery of behavioural support interventions has also not yet been systematically examined.

Aims: The broad aims of this project are related to: i) developing a reliable method for specifying the content of smoking cessation behavioural support interventions in practice; ii) develop a training manual to train novice coders in the application of the latter method; iii) assess the quality and fidelity of behavioural support interventions in the NHS stop smoking services; iv) examine the association between intervention content and quit outcomes.

Methods: The first phase of this research will focus on examining the extent to which a reliable taxonomy of 43 smoking cessation BCTs may be applied or adapted to identify BCTs delivered in practice by NHS services. The taxonomy will be applied as a coding framework to identify and categorise BCTs featured in transcripts of audio-recorded behavioural support sessions delivered in distinct NHS services. An accompanying coding training manual will be developed and evaluated. A systematic review of intervention fidelity assessment strategies will be conducted. Fidelity of delivery will then be assessed by using the taxonomy to code both transcripts of audio-recorded NHS service sessions (i.e. actual practice)  and accompanying service manuals (i.e. recommended practice) into component BCTs and compare discrepancies in the number and type of techniques identified.  A quality rating scale and accompanying scoring criteria will be developed and piloted on transcripts of audio-recorded sessions. Associations between BCTs identified in practice transcripts and session quit rates will be assessed using logistic regression.

1. Prediction and management of cardiovascular risk for people with severe mental illnesses. A research programme and trial in primary care (PRIMROSE)

Principal Investigator: Dr David Osborn, University College London

Co-Investigators: Professor Susan Michie, Dr Kate Walters, Professor Michael King, Professor Irwin Nazareth, Professor Stephen Morris, Dr Omar Rumana, Dr Irene Peterson, Dr Louise Marston, Professor Richard Morris (University College London), Professor Robert Pevelar, Professor Richard Holt (University of Southampton), Dr John Larsen, Ms Janey Antoniou (Rethink Mental Illness), Ms Claire Johnston (Camden & Islington NHS Foundation Trust), Professor Thomas Barnes (Imperial College London), Professor Tom Craig (Institute of Psychiatry)

Research Fellow: Dr Lou Atkins, University College London

Background: People with severe mental illness (SMI) die significantly earlier than the general population (Parks et al., 2006). The majority of these premature deaths (66%) are due to treatable conditions such as cardiovascular disease (CVD) (Brown, 1997).
Increased mortality risk for CVD appears to be age-related; people with SMI <50 years carry a three-fold risk of death from CVD and two-fold risk between 50-75 years (Osborn et al., 2007). These conditions in people with SMI tend to go undetected despite frequent contact with health care services, especially primary care. They have increased CVD risk factors including diabetes, smoking, obesity and abnormal lipids. We do not have accurate risk scores to predict CVD risk in people with SMI and we do not know which strategies work to reduce their risk in the long term. NICE has recommended research to address both these gaps in knowledge.

Aims: This programme of work has two aims: i) To develop a CVD risk score tool specifically for people with SMI. ii) To develop and test a primary care nurse-delivered intervention to manage CVD risk in people with SMI.

Methods: We will conduct a systematic review to inform development of the intervention. We will conduct focus groups with practice nurses, GPs and people with SMI to explore barriers and levers to implementing the intervention. We will use technologies developed within the Health Psychology Research Group to frame questions asked in focus groups (Theoretical Domains Framework, Michie et al, 2005). We will synthesise evidence from the systematic review and focus group to finalise the intervention to manage CVD risk in people with SMI. We will conduct a multi-centre randomized controlled trial of the intervention in primary care, on a well-established network of general practices which have expertise in research. 40 general practices will be involved, 20 using the new intervention and 20 providing standard care. 400 people with SMI will take part and receive the intervention for one year. We will establish whether nurses trained in the intervention reduce cholesterol more than the standard care.

Brown S. (1997) Excess mortality of schizophrenia. Br J Psychiatr 171: 502-508
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A (2005) Making psychological theory useful for implementing evidence based practice: a consensus approach. BMJ Qual Saf 14: 26-33
Osborn DPJ, Levy G, Nazareth I, Petersen I, Islam A, King M (2007) Relative risk of  cardiovascular and cancer mortality in people with severe mental illness from the UK General Practice Research Database. Archives of General Psychiatry 64:242-249.

2. Assessing the impact of the NHS Health Trainers Service

Principal Investigator: Professor Susan Michie, University College London

Researchers: Dr Ben Gardner; Dr James Cane

Background: The NHS Health Trainers Service was set up to tackle inequalities in health by providing one-on-one motivational and practical support to “hard to reach” members of local communities. The Service focuses particularly on those who are at a greater risk of poor health with an aim to help them achieve their own health goals. Since the inception of the Health Trainers Service in 2006, CORE has played a central role in producing annual audits of the Service, evaluating activity within the Service and assessing its impact in changing health behaviours and reducing health inequalities.

Aims: The aims of this programme of work are to: i) assess the impact of the NHS Health Trainers Service in changing health behaviours, and in reaching the target population, and ii) to identify the psychological mechanisms through which positive health behaviour change is achieved.

Methods: The Health Trainer Data Collection and Reporting System (DCRS) systematically accumulates data relating to health behaviours, psychological variables and Health Trainer workforce characteristics. Using this data, evidence relating to the activity and impact of the Health Trainers Service is compiled and used to inform the development of the Service, to identify the benefits of the Health Trainer approach, and to enhance understanding of assisted health behaviour change.

Smith, J., Gardner, B., Michie, S. (2010). Health Trainers: National End of Year Report: 2008-09. Report to Department of Health.