A detailed description of the Smoking Treatment Optimisation in Pharmacies (STOP) intervention showing underpinning theory and behaviour change techniques
| Content | Theoretical basis | Behaviour change techniques | |
| Pharmacy visit |
Explain the study to pharmacist in charge or manager. Mention potential revenue stream from smoking cessation. Emphasise to staff how this fits well with their wider role in health promotion. Raise awareness in all staff in preparation for invitation to training. Emphasise intervention is brief. Address preimplementation concerns. Provide financial incentive for attending training (£30 per session, only received on completion of training). Emphasise backing from local and national opinion leaders and organisations (eg, Local Pharmaceutical Committee, Royal Pharmaceutical Society, local CCGs and public health commissioners). |
Adoption by individuals: concerns in preadoption stage (DIT) The innovation: compatibility; relative advantage; low complexity (DIT) Outer context: incentives (DIT) Diffusion and dissemination: opinion leaders (DIT) |
10.2 Material incentive (behaviour) 9.1 Credible source 1.2 Problem Solving 6.3 Information about others’ approval |
| Training session 1 | |||
| Introductions | General orientation to the STOP programme, information on aims of training. Include discussion of the impact of adviser behaviour on client stop smoking outcomes and health benefits to patients from stopping smoking. Communicate the advantages of the STOP intervention over usual practice, stress it's brief and show how it fits with overall ‘pharmacy’ identity. | Outcome Expectancies (SCT) The innovation: relative advantage; compatibility; low complexity (DIT) | 9.1 Credible source 5.1 Information on health consequences of behaviour 15.1 Verbal persuasion about capability |
| Topic 1: why are we here? | Exploration of motivation for helping smokers to quit. Does engaging and supporting smokers’ quit fit with role identity, any barriers? Encourage self perception as supporters and providers of health, how one will feel if help smokers quit. Emphasise the non-medication-related, professional and public health aspects of the pharmacy role, promote a person-centred rather than product-centred ethos and foster a strong sense of professionalism. | Intrinsic and extrinsic motivators (SDT) The innovation: compatibility (DIT) | 5.6 Information about emotional consequences 9.2 Pros and cons 6.3 Information about others approval 13.1 Identification of self as a role model |
| Topic 2: engaging clients | Group discussion of difficult/easy clients to engage—what are potential problems, solutions? Introduction of patient-centred approach and basic communication skills including, rapport, listening and questioning. Role-play demonstration with senior pharmacist, participant practice. How to maximise opportunity with environmental resources for example, tar jars. Staff badges prompting client interaction. Addressing pharmacy workers beliefs and attitudes, for example, prejudgement of success or failure. Emphasise predictable improved result., | Self-efficacy (SCT) Modelling (SCT) Vicarious learning (SCT) The innovation: relative advantage; compatibility; low complexity (DIT) | 1.2 Problem solving 4.1 Instruction on performance of behaviour 6.1 Demonstration of behaviour 8.1 Behavioural practice and rehearsal 7.1 Prompts and cues |
| Topic 3: is this the right time? | Information on how to assess whether someone is ready to quit smoking. Using 1–10 scales to assess readiness to change and importance of change for the smoker. Role-play practice. Does engaging and supporting smokers’ quit fit with role identity? | Self-efficacy (SCT) Self-regulation (SCT) The innovation: compatibility (DIT) | 4.1 Instruction how to perform behaviour 8.1 Behavioural practice and rehearsal |
| Topic 4: homework (revise NCSCT training, discuss how the intervention might be applied within your pharmacy) | Encouragement to revise NSCSCT training in smoking cessation, including quizzes. Task to discuss as a pharmacy how might implement the STOP programme within their specific pharmacy—what would be facilitators or barriers? Emphasise testing, trialling and adaptation to local circumstances. | Self-efficacy (SCT) Self-regulation (SCT) The Innovation: trialabilty (DIT) | 1.1 Goal setting (behaviour) 1.2 Problem solving |
| Training session 2 | |||
| Topic 1: feedback and reflections from homework | Discussion of homework. Key things learnt from completing NCSCT related training. Goal setting for filling in gaps. Identification of organisational barriers, facilitators to implementing STOP in individual pharmacies. Facilitating action plans to implement STOP in their pharmacy. Any further thoughts on how the intervention can be adapted to local circumstances? | Self-regulation (SCT) The Innovation: fuzzy boundaries (DIT) Adoption by individuals: concerns in preadoption stage (DIT) | 2.7 Feedback on outcome of behaviour 1.1 Goal setting 1.2 Problem solving 1.4 Action planning |
| Topic 2: challenge of changing behaviour and maintaining a client-centred stance | Brainstorming on what influences people to change behaviour—the role of beliefs, capability and opportunity in addition to knowledge. How to elicit individuals’ motivations, barriers and potential strategies to change behaviour versus offering solutions. Using ‘What else questions’. Understanding the ‘non-smoker identity’ and how to communicate to client. Demonstration and role-play. What makes this client-centred approach difficult, advantages, disadvantages, barriers and strategies to aid implementation. | Outcome expectancies (SCT) Modelling (SCT) Self-efficacy (SCT) | 4.1 Instruction on how to perform behaviour 6.1 Demonstration of behaviour 8.1 Behavioural practice and rehearsal 9.2 Pros and cons 1.2 Problem solving |
| Topic 3: planning a quit and dealing with lapses | Planning a quit—How to help people make a specific plan using a SMART approach. Setting own SMART goal. What to do if someone has a lapse, how to maintain support without excessive praise. Watch and reflect on video of strong and weak consultations of quit planning. Discussion of how to talk about willpower and the role of the open door. Demonstration and role-play. | Modelling (SCT) Self-efficacy (SCT) | 4.1 Instruction on how to perform behaviour 1.1 Goal setting (behaviour) 6.1 Demonstration of behaviour 8.1 Behavioural practice and rehearsal |
| Topic 4: implementing STOP | How to translate training to practice —barriers and solutions. Use of prompts/cues including the Double Whammy (a desk top reminder with visual cues and example questions to ask) and badges prompting client interaction. Introduction of social media support Using client wallet cards to remind patients of quit plans and motivators. | Self-regulation (SCT) Intrinsic/extrinsic motivators (SDT) The innovation: augmentation/support (DIT) | 4.1 Instruction on how to perform behaviour 1.2 Problem solving 7.1 Prompts and cues 3.1 Social support (practical and emotional) |
| Topic 5: goal setting and making a commitment | Develop a goal and elicit a commitment from participants to deliver STOP programme. Participants provided with a certificate for attending the training which is eligible for CPD points. | Modelling (SCT) Intrinsic/extrinsic motivators (SDT) Outer context: incentives (DIT) | 15.1 Verbal persuasion about capability 1.1 Goal setting (behaviour) 1.9 Commitment 10.2 Material reward |
| Follow-up visit |
Promote adaptation of non-core elements of the intervention through a prompted pharmacy team meeting to discuss implementation of the intervention according to the needs of each individual pharmacy for example, appointment of individual champions, monthly ‘STOP’ smoking days. Provide financial reward for those who have completed intervention training. |
The innovation: trialability; reinvention; fuzzy boundaries; champions (DIT) |
1.4 Action planning 10.2 Material reward |
| Be delivered in mixed groups of pharmacists and other pharmacy workers to promote cohesive working practices within the individual pharmacies. | Implementation and routinisation: organisational structure (DIT) | 3.2 Social support (practical) |
Features of the initial intervention are in roman text and final intervention in italics.
NCSCT, National Centre for Smoking Cessation Training; CCG, Clinical Commisioning Group; DIT, Diffusion of Innovations Theory; SCT, Social Cogntiive Theory; SMART, Specific, Measurable, Attainable, Realistic, Timely; CPD, Continuing Professional Development.