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Using Behaviour Change Technique (BCT) analysis to improve fidelity to treatment manuals in smoking cessation: A case study Billie Bonevski, Laura Twyman, Fabiana Lorencatto, Susan Michie & Robert West Newcastle, Australia 2 The Trial • The primary aim is to evaluate the efficacy of a community social service case-worker delivered smoking cessation intervention for socially disadvantaged smokers • The study design is a randomised controlled trial • The primary outcome measure is CO verified continuous abstinence at 6 months follow-up 3 The Call it Quits smoker (n = 309) 4 The case-worker delivered intervention: Key components • • • • • • • Delivered by trained volunteer case-workers Systematically (electronically) assessing and recording smoking status in client notes Tailored (based on print-out) Provision of advice to quit and behavioural counselling, motivational interviewing if required over two face-to-face sessions Free nicotine replacement therapy Buddy system Flexible follow-up through telephone calls, or drop-ins But what are our intervention participants really receiving? 5 The aims of the current study 1. Assess volunteer case-worker fidelity to the Call it Quits intervention manual using BCT analysis 2. Assess the effectiveness of BCT performance feedback in improving fidelity to intervention manual 6 Methods • Pre and post test study embedded in one intervention trial (Call it Quits) • 6-week pre-test period of recording counselling sessions • 6-week period post-intervention of recording counselling sessions • Main outcome: – Proportion of each manual specified BCT delivered pre and post 7 Methods 8 Intervention manual coded using BCT smoking cessation framework Pre-test: Counselling sessions audio recorded and transcribed Code transcriptions - BCTs Intervention: Volunteer case-workers provided with BCT performance feedback Post-test: Counselling sessions audio recorded and transcribed Code transcriptions - BCTs Results: BCTs coded in the manual Tailor interaction appropriately Facilitate goal setting Boost motivation and self efficacy Prompt review of set goals Provide feedback on current behaviour and progress Advise on stop smoking medication Provide rewards contingent on not smoking Advise on/facilitate the use of social support Prompt commitment from the client there and then Ask about experience of stop smoking medication that the smoker is currently using Provide rewards contingent on effort or progress Give options for additional and later support Facilitate identification of reasons for wanting and not wanting to stop smoking General communication approach Explain the importance of abrupt cessation Facilitate relapse prevention and coping Conduct motivational interviewing Promote cut-down-quit Facilitate barrier identification and problem solving Advise on management of mental health problems Information gathering and assessment Assess alcohol or drug use disorder Facilitate action planning/develop a treatment plan Arrange follow-up session 9 Pre-test Results - Volunteer case-worker session recordings (n=23) Individual Volunteer B 1st F2F A P 1 2nd F2F 1st t/c I G 5 1 2 1 S K Total 2 9 3 5 1 2nd t/c 2 2 1 Final t/c 1 1 Total 2 2 3 7 Duration (mins) 2.13.4 2.533.2 3.47.6 425.6 3 1 1 1 5 3 7.5 312.5 3.146.4 4 2.5 - 46.4 10 Inter-rater reliability • 50% of pre-test coding • Between two coders (BB & LT) • Assessed using percentage agreement • 79% (High - > 75%) 11 Pre-test Results - Number of face to face sessions each BCT delivered in (out of possible 14) 12 N (%) BCT label N (%) Tailor interaction appropriately 8 (57) Facilitate goal setting 9 (64) Boost motivation and self efficacy 3 (21) Prompt review of set goals 0 Provide feedback on current behaviour and progress 10 (71) Advise on stop smoking medication 14 (100) Provide rewards contingent on not smoking 0 Advise on/facilitate the use of social support 13 (93) Prompt commitment from the client there and then 9 (64) Ask about experience of stop smoking medication that the smoker is currently using 12 (86) Provide rewards contingent on effort or progress 6 (43) Give options for additional and later support 3 (21) Facilitate identification of reasons for wanting and not wanting to stop smoking 5 (36) General communication approach 14 (100) Explain the importance of abrupt cessation 6 (43) Facilitate relapse prevention and coping 5 (36) Conduct motivational interviewing 3 (21) Promote cut-down-quit 12 (86) Facilitate barrier identification and problem solving 6 (43) Advise on management of mental health problems 1 (7) Information gathering and assessment 13 (93) Assess alcohol or drug use disorder 10 (71) Facilitate action planning/develop a treatment plan 14 (100) Arrange follow-up session 14 (100) Pre-test Results - Number of telephone sessions each BCT delivered in (out of possible 9) 13 N (%) BCT label N (%) Tailor interaction appropriately 3 (33) Facilitate goal setting 0 Boost motivation and self efficacy 8 (89) Prompt review of set goals 2 (22) Provide feedback on current behaviour and progress 8 (89) Advise on stop smoking medication 2 (22) Provide rewards contingent on not smoking 1 (11) Advise on/facilitate the use of social support 4 (44) Prompt commitment from the client there and then 0 Ask about experience of stop smoking medication that the smoker is currently using 5 (56) Provide rewards contingent on effort or progress 4 (44) Give options for additional and later support 8 (89) Facilitate identification of reasons for wanting and not wanting to stop smoking 2 (22) General communication approach 7 (78) Explain the importance of abrupt cessation 0 Facilitate relapse prevention and coping 2 (22) Conduct motivational interviewing 0 Promote cut-down-quit 3 (33) Facilitate barrier identification and problem solving 2 (22) Advise on management of mental health problems 3 (33) Information gathering and assessment 2 (22) Assess alcohol or drug use disorder 3 (33) Facilitate action planning/develop a treatment plan 0 Arrange follow-up session 5 (56) BCT Performance feedback intervention Group feedback session outlining: – Number of recordings per volunteer – BCTs specified in manual – BCTs delivered by each volunteer (anonymous) – Positive reinforcement – Discussion of BCTs, identification of aids to help boost BCT use Individual performance feedback letters including: – Length of sessions (in minutes) – List of BCTs identified and positive reinforcement – List of BCTs not coded – Goal setting – increase unused BCTs in 6 months 14 BCT Performance feedback intervention 15 • Desktop checklist with ‘top 5’ BCTs – goal for improvement In face-to-face sessions 1. Explain the importance of abrupt cessation 2. Prompt commitment from the client there and then 3. Facilitate action planning/develop a treatment plan 4. Facilitate goal setting 5. Advise on stop smoking medication In telephone follow-up calls 1. Prompt review of set goals 2. Provide feedback on current behaviour and progress 3. Boost motivation and self-efficacy 4. Facilitate relapse prevention and coping 5. Provide rewards contingent on effort or progress Next steps • Continue coding post-test sessions • Compare pre and post test use of manual specified BCTs • Assess by – session type (face to face, telephone follow-up) – duration, – volunteer – BCT • Assess inter-rater reliability for new BCTs 16 THANK YOU Funding: •National Health & Medical Research Council •Cancer Institute NSW •Hunter Medical Research Institute •Anglicare Community Care Centre Wollongong clients, volunteers and staff Contact me on: [email protected] or ph: +61 02 40335710 CRICOS Provider 00109J | www.newcastle.edu.au 17