Evaluation of the Stop Smoking, Start Living (S3L) project

A clinician behaviour intervention (CBI) will increase sustained use of a multifaceted evidence-based intervention (“bundle”) targeting smokers from general and High-Risk Populations. Elements of the bundle are: 1. Brief counselling 2. Nicotine Replacement Therapy (NRT) 3. A text messaging program (TMP) S3L Implementation staff are asked to complete the NSW Health HETI smoking cessation module (https://www.heti.nsw.gov.au/education-and-training/courses-and-programs/smoking-cessation-a-guide-for-all-staff). This is the standard default module provided to NSW health staff and covers the approach to counselling and NRT. This material was developed by HETI/NSW Health and has been adopted as current practice by the project. 1. Brief counselling Brief smoking cessation counselling is included in the intervention bundle as per NSW Health Smoke-free Health Care Policy PD2015_003. Specific counselling guidelines are as per My Health Learning Module Smoking cessation: a guide for staff, which details the 5As approach. The Smoking Cessation 5As is a guide to a once-off interaction that should take place at least once with each admitted patient ( https://www.health.nsw.gov.au/tobacco/Factsheets/tool-2-guide-5as.pdf). S3L aims to endorse and increase staff compliance with Policy PD2015_003. S3L does not set any specific quotas in terms of duration and frequency of 5As counselling, rather, any extent to which staff engages with smoking cessation practices is encouraged and supported. 2. NRT NRT is offered by ward staff to eligible patients as per NSW Health directive. Staff are directed to offer NRT in line with three NSW Health Tools for Assessing Nicotine Dependence and NRT prescription (https://www.health.nsw.gov.au/tobacco/Factsheets/tool-3-assessing-nicotine.pdf, https://www.health.nsw.gov.au/tobacco/Factsheets/tool-4-nrt-in-hospital.pdf and https://www.health.nsw.gov.au/tobacco/Factsheets/tool-5-quick-guide-nrt.pdf). For patients who smoke, this involves having their nicotine dependence assessed by a health care professional, if clinically appropriate being offered NRT, and if accepted, the relevant NRT product/s charted and administered as part of their inpatient medications. The duration and frequency of the therapy is as deemed clinically appropriate by the medical team. Usually, nicotine patches are prescribed once every 24hour period, while oral NRT products are often provided to the patient as Po Re Nata (PRN) . To support longer term access to NRT on discharge, patients are offered at least three days’ supply of the NRT product/s they received during admission, as well as a PBS prescription if applicable (applies to Nicotine Patches only). 3. TMP Ward staff inform patients who smoke of a new quit support TMP and sign them up to it if they are interested in receiving the messages. Registered patients receive 120 messages over 12 weeks. An example of a text message is: "If you're feeling a bit sick when using your NRT, you might be swallowing too much nicotine from lozenges. Try resting it more in the side of your mouth." The full library can be viewed on request. Recipients cannot respond to messages but there is the option to opt-out in each text. The system allows for tracking of enrolment and opt-outs. 4. Tc TRANSLATE- cessation (Tc) is a 3-month program offered to implementation leads (ILs) that includes the provision of evidence-based tailored training and support materials, regular online training and coaching sessions as well as a support team based at UNSW that is available during business hours. Tc aims to upskill ILs to support adoption of the S3L intervention within their organisation. ILs are NSW Health staff who are already employed within the respective Local Health Districts, in either clinical (e.g. nurse) or non-clinical (e.g. Health Promotion Officers) roles. Support provided to ILs by the project team is through Microsoft Teams and email correspondence, as well as by their respective S3L District Leads. Phase 1: Recruitment of Implementation Teams ILs are supported to recruit ward staff as part of their Implementation Team on intervention wards with resources such as informative handouts, presentation slides, and email templates. The exact IL recruitment process depends on local factors such as familiarity with ward staff and ward engagement and support. Phase 2: Engagement with Implementation Teams ILs organise three (~1 hour) meetings with their Implementation teams and a fourth meeting with the Nurse Unit Manager (~30 minutes) to co-design and prepare for the S3L intervention. Prior to each meeting, a coaching session held by the project team on Microsoft Teams aims to prepare ILs for the upcoming Implementation team meeting. Implementation Team meetings are held online or in-person depending on team preference. Phase 3: Rollout of S3L The roll out of S3L occurs once implementation staff are training but is a variable process depending on ward specific factors such as IL availability, ward engagement and preferences. Digital resources are provided to ILs to support implementation, including a Smoking Cessation Tool (SCT) which is made available electronically and as hardcopy.