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Opportunities for implementing smoking cessation interventions in primary care: a Breathe Well study
(The International Primary Care Respiratory Group (IPCRG), 2022-05)
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Krstevska, Emilija
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Simonovska, Sara
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Trpcheski, Filip
Aim: To explore the acceptability to general practitioners (GPs) and patients of delivering and receiving lung age (LA) or exhaled CO feedback combined with very brief advice (VBA), or VBA alone, as part of a process evaluation of a randomized controlled trial (RCT). Method: Individual semi-structured interviews were conducted with GPs and patients involved in a smoking cessation trial from different regions in North Macedonia, sampled to ensure maximum variation of socio-demographic characteristics, smoking habits and motivation to quit smoking among patients, and characteristics and experience of GPs. Interviews were audio-recorded, transcribed intelligent verbatim, and analysed using the Framework method. Results: 26 GPs and 31 patients were interviewed. The patients who expressed a willingness to or had attempted to quit smoking after the interventions, associated quitting with strong motivation and resilient character. An important theme identified from interviewing patients was “Relationship-based care”: the importance of trust, strong relationships and communication between patients and GPs. For some patients this was the only reason to participate in the study, discuss cessation, receive intervention and attempt or succeed to quit. In contrast, GPs were influenced by a “system-view/approach to primary healthcare” which was not traditionally based on a culture of prevention, and in future they anticipated offering cessation advice and interventions, in their own time to those motivated to quit, or with pre-existing health problems. They preferred LA over CO. Conclusion: GPs are keen to support motivated patients to quit but need help to understand the motivations of those less inclined to quit, and have strategies to support them too. The primary care system needs to be improved to value prevention more. This study is a milestone in N. Macedonia, as a start of preventive-standard care and shifting patients’ expectations of primary care services. Declaration of Interest (including funding source and trial registration as appropriate) The authors declare no conflicts of interest. The NIHR Global Health Research (GHR) Programme is funded through UK Official Development Assistance (ODA) via the Department of Health and Social Care (DHSC). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. We gratefully acknowledge IPCRG for introducing us to the primary care networks involved in this study and for its continued facilitation of clinical engagement. The study is registered at http://www.isrctn.com (ISRCTN54228638). Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest References and Clinical Trial Registry Information
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Factors associated with previous quit attempts and motivation to quit, amongst primary care patients who are current smokers in Macedonia: a Breathe Well study
(Centar of Family Medicine, Faculty of Medicine, “Ss. Cyril and Methodius“ University in Skopje, 2021-05)
Stanoevski, Gjorgji
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Jordan, Rachel
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Adab, Peymanne
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Enocson, Alexandra
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Aim To explore the association between level of nicotine dependence and previous quit attempts and motivation to quit smoking amongst primary care patients. Method We analysed baseline questionnaire data from a randomized controlled trial of a smoking cessation intervention in 31 primary care practices in North Macedonia. Participants were aged ≥35 years and smoked >10 cigarettes/day. Regression models assessed associations between nicotine dependence (Fagerstrom) and intention to quit and previous attempts to quit, adjusting for sociodemographic variables. Results Data was available for 1328 patients. Participants had a mean age of 51,2 (SD 10,3) years, reported a mean smoking history of 39,3 (SD 22,7) pack years and 51% (n=679) were female. 83% (n=1100) of participants were of Macedonian ethnicity. 702 participants (52.9%) reported either moderate or high nicotine dependence. Approximately half of the participants (707/1328, 53.2%, reported previous serious quit attempts, with the majority of these (565/707, 79.9%) reporting 1-3 attempts. Regarding current motivation for quitting, the majority (69.2%) wanted to quit, and 78 (6%) intended to quit in the next 1-3 months. Participants with high nicotine dependence were less likely to have made previous quit attempts (OR=0.90; 95%CI 0.85 to 0.95). Nicotine dependency showed no significant association with current intention to quit (OR=1.00; 95% CI 0.90 to 1.12). Conclusion We found that the majority of smokers want to quit, but those with higher nicotine dependency were less likely to have made previous quit attempts. Declaration of Interest (including funding source and trial registration as appropriate) The authors declare no conflicts of interest. The NIHR Global Health Research (GHR) Programme is funded through UK Official Development Assistance (ODA) via the Department of Health and Social Care (DHSC). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. We gratefully acknowledge IPCRG for introducing us to the primary care networks involved in this study and for its continued facilitation of clinical engagement. The study is registered at http://www.isrctn.com(ISRCTN54228638)
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Strengthening Clinician-Researchers' Communication and Knowledge Translation Skills: An Innovative Game Model From the Breathe Well Group
(Sage Publishing, 2024-09-12)
Williams, Siân
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Fernandes, Genevie
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Adab, Peymané
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Adams, Rachel
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de Sousa, Jaime Correia
Communication is a core component of a clinician's role; however, when clinicians conduct research, communicating the emerging findings and recommendations to different types of stakeholders can be unfamiliar territory. Communicating research to advocate for change can be even more challenging. Clinician researchers seeking to be agents for change need to conceive and craft specific, evidence-based messages and communicate these effectively to different stakeholders to negotiate action. As part of a global health research program, we developed and tested a novel game-based model to strengthen the communication skills of clinician researchers, from 4 countries, for improving services for chronic obstructive pulmonary disease. This model focused on communication with 3 key stakeholder groups for knowledge translation: Patients/carers, healthcare providers and policy makers/healthcare managers. Delivered through a series of facilitated, online meetings, this model consisted of 2 parts: developing and rehearsing advocacy messages with coaching support, and then testing them with a panel of 3 representative stakeholders, and an audience of fellow researchers. All the country teams reported increased confidence in crafting advocacy messages for specific stakeholders and have applied lessons learned from the model. Delivering this model within a global health research program requires mentoring, time, commitment, resources and translation support to address language barriers. It offers an exemplar to build the communication skills of clinician and non-clinician researchers so that they can go beyond dissemination toward translation of evidence into policy and practice.
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Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group
(BMJ Publishing Group, 2021)
Pan, Zihan
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Dickens, Andrew P
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Chi, Chunhua
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Kong, Xia
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Enocson, Alexandra
To examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population.
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Effectiveness of Combining Feedback about Lung Age or Exhaled Carbon Monoxide Levels with Very Brief Advice (VBA) and Support for Smoking Cessation in Primary Care Compared to Giving VBA and Support Alone â€“ Protocol for a Randomized Controlled Trial withi
(Scientific Foundation SPIROSKI, 2020-03-25)
Gjorgjievski, Dragan
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Ristovska, Radmila
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Farley, Amanda
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Adab, Peymane
INTRODUCTION: In 2015, smoking prevalence in Republic of Macedonia was 36% in men and 21% in women We aim to assess the effectiveness and cost-effectiveness of two methods of motivating smokers to quit smoking compared with very brief advice (VBA) alone. To date, there are no studies investigating smoking cessation treatment in Republic of Macedonia. METHODS/DESIGN: RCT with process evaluation and cost-effectiveness analysis within 31 general practices in Republic of Macedonia recruiting smokers currently smoking >10 cigarettes per day, aged >35 years, attending primary care practices for any reason, regardless of motivation to quit smoking. Respondents will be randomized into one of three groups: (1) VBA and assessment and communication of lung age; (2) VBA and additional assessment and communication of exhaled carbon monoxide (CO) levels; or (3) control group â€“ VBA. All participants who attempt to quit smoking will be offered behavioral support based on the UK standard program for smoking cessation. Primary outcome: Proportion of smokers who are quit at 4 weeks (7-day point prevalence, confirmed by salivary cotinine level). Secondary outcomes: Proportion who have attempted to quit smoking or have quit smoking, a proportion that has reduced the number of cigarettes and motivation to quit smoking; cost-effectiveness analysis calculating cost per quality-adjusted life year. We will evaluate the fidelity to the intervention and will explore patientsâ€™ and GPsâ€™ experience and the acceptability of the study intervention by interview. DISCUSSION: The study will evaluate the effectiveness of combining feedback about lung age or exhaled CO levels with VBA and support for smoking cessation in primary care compared to giving VBA and support alone. It will explore how willing primary care physicians are to perform such interventions and the acceptability and effectiveness of such interventions to patients in Republic of Macedonia. TRIAL REGISTRATION: The study is registered on the ISRCTN registry (ISRCTN54228638).

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