Effectiveness of a brief self-determination intervention for smoking cessation in emergency departments : a randomised controlled trial

Abstract

Background. Previous studies have shown that Emergency Departments (EDs) that identify, advise, and then refer patients who are smokers to smoking cessation services see an increased short-term quit rate in those patients. The results of this study have significant implications for healthcare practice in Hong Kong, since EDs are major healthcare providers in this region, yet ED-based interventions that promote smoking cessation have not been tested for efficacy in Hong Kong and are therefore not currently established. Aim. The present study examines the effectiveness of a brief, Self-Determination Theory (SDT) smoking cessation intervention that targeted adult patients who visited four public EDs in Hong Kong. Methods. A randomised control trial (RCT) was conducted. Eligible adult smokers who presented to the ED for care during data collection were randomised into intervention or control groups. The intervention consisted of one on-site intervention and four follow-up phone calls at 1-, 3-, 6-, and 12-months post ED visit. The principles of SDT, which emphasises autonomous decision and minimised control, were adopted to inform the intervention design, and the AWARD model was used to guide the intervention delivery. This model consisted of Asking about a smoking history, Warning about the harmful effects of smoking to personal health, Advising the participant to quit to promote their health, Referring the participant to a smoking cessation service, and Doing-it-again, where four phone-calls were made at 1-, 3-, 6-, and 12-months to boost intervention. Participants in the intervention group could choose to quit immediately or progressively. Participants in the control group received an on-site brief intervention and four phone-calls at the same intervals as the treatment group that advised about the importance of regular exercise and balanced diet. The primary and secondary outcomes were the biochemical quit rate at 6-month and 12-month follow up, respectively, in the intervention and control group. In this study, data were analysed from one of the four EDs that accounted for more than 60% of the participants. Results. The biochemical quit rate was significantly higher in the intervention group compared to the control group at the 6-month follow-up (5.5% Vs 2.3%, p<0.01), but was not significantly higher at the 12-month follow-up (4.8% Vs 3.0% p=0.16). Conclusion This study demonstrated that participating in our SDT-based smoking cessation intervention significantly increased the likelihood that adult ED patients who smoked would quit smoking. Implications for practice Further strategies should focus on increasing uptakes of adult smokers by health care professionals and revising the contents of interventions to improve the effectiveness of smoking cessation programs used within clinical practice.