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Determining counselling communication strategies associated with successful quits in the National Health Service community pharmacy Stop Smoking programme in East London: a focused ethnography using recorded consultations
  1. Carol Rivas1,2,
  2. Ratna Sohanpal2,
  3. Virginia MacNeill3,
  4. Liz Steed2,
  5. Elizabeth Edwards2,
  6. Laurence Antao2,
  7. Chris Griffiths2,
  8. Sandra Eldridge2,
  9. Stephanie Taylor2,
  10. Robert Walton2
  1. 1 Social Science Research Unit, University College London, London, UK
  2. 2 Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  3. 3 Department of Public Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr. Carol Rivas; c.rivas{at}


Objectives To determine communication strategies associated with smoking cessation in the National Health Service community pharmacy Stop Smoking programme.

Setting 11 community pharmacies in three inner east London boroughs.

Participants 9 stop smoking advisers and 16 pairs of smokers who either quit or did not quit at 4 weeks, matched on gender, ethnicity, age and smoking intensity.

Method 1–3 audio-recorded consultations between an adviser and each pair member over 5–6 weeks were analysed using a mixed-method approach. First a content analysis was based on deductive coding drawn from a theme-oriented discourse analysis approach and the Roter Interaction Analysis System. Core themes were identified through this quantification to explore in detail the qualitative differences and similarities between quitters and non-quitters.

Results Quantitative analysis revealed advisers used a core set of counselling strategies that privileged the ‘voice of medicine’ and often omitted explicit motivational interviewing. Smokers tended to quit when these core strategies were augmented by supportive talk, clear permission for smokers to seek additional support from the adviser between consultations, encouragement for smokers to use willpower. The thematic analysis highlighted the choices made by advisers as to which strategies to adopt and the impacts on smokers. The first theme ‘Negotiating the smoker–adviser relationship’ referred to adviser judgements about the likelihood the smoker would quit. The second theme, ‘Roles of the adviser and smoker in the quit attempt’, focused on advisers’ counselling strategies, while the third theme, ‘Smoker and adviser misalignment on reasons for smoking, relapsing and quitting’, concerned inconsistencies in the implementation of National Centre for Smoking Cessation and Training recommendations.

Discussion Advisers in community pharmacies should use the advantages of their familiarity with smokers to ensure appropriate delivery of patient-centred counselling strategies and reflect on the impact on their counselling of early judgements of smoker success.

  • smoking cessation
  • community pharmacies
  • qualitative research
  • communication
  • focused ethnography

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors RW conceived the study. CR undertook the analysis and wrote the manuscript. RS, LA and VM were involved in data collection. RS, LS and RW contributed to the data analysis and interpretation. VM, LS, LA, EE, CG, ST, SE and RW were involved in revising the article critically and contributing important intellectual content. RW is the guarantor.

  • Funding NIHR Programme grant RP-PG-0609-10181.

  • Competing interests None declared.

  • Ethics approval NRES Committee South Central - Berkshire B (reference number: 13/SC/0189.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This study analyses qualitative data and the advisers and smokers did not consent to have their full consultation transcripts made publicly available. They consented for their data to be stored for 5 years as part of the 5-year programme grant project and to be used in this or other studies directly linked to the 5-year project. Supporting excerpts from the raw data (quotes from consultations) are available within the text of the paper. Full transcripts (with identifying information removed) will be available, following completion of the project, on request from the study guarantor, Robert Walton,

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