Evidence from reviews of behavioural interventions Robert West University College London September 2008

Aims To review the effectiveness of behavioural support modalities providers content target populations To consider implications for future research

Behavioural support Advice, encouragement and activities designed to: maximise motivation to maintain abstinence e.g. using anticipated praise and shame; fostering sense of achievement minimise motivation to smoke e.g. advising on stress reduction, avoiding high-risk situations improve medication adherence e.g. explaining mechanism of action enhance self-regulatory skills and capacity e.g. teaching strategies for resisting urges in smokers seeking help with stopping

Cochrane reviews on behavioural support Modes of delivery One-to-one face-to-face Group face to-face Telephone Types of provider Nurses Pharmacists Target populations Patient pre-operation Hospital inpatients Pregnant smokers Smokers in the workplace Intervention components Promoting physical exercise Hypnotherapy Use of biomarkers Relapse prevention Aversive smoking Enhancing partner support Competitions and incentives

Review summaries + Good evidence for clinically significant effect +? Evidence suggestive of a clinically significant effect ? Insufficient evidence to draw a general conclusion -? Evidence suggestion of no clinically significant effect Good evidence for no clinically significant effect

Modes of delivery Conclusion Issues One-to-one face-to-face + No clear effect of intensity Group face to-face Not clearly different from one-to-one Telephone Mostly lacking biochem verification Written materials +? Small overall effect and heterogeneous

Types of provider Conclusion Issues Nurses + Mixes different intervention types; advice and support during healthchecks not found to be effective Pharmacists +? Limited data

Target populations Conclusion Issues Patients before surgery + Short-term effect Hospitalised patients Only in those also offered medication and support after discharge Pregnant smokers Appears to require dedicated specialist Smokers in the workplace Similar to support given in other contexts

Intervention components Conclusion Issues Promoting physical exercise ? Limited data Hypnotherapy No evidence for specific effect but heterogeneity Use of biomarkers Limited data: new studies not included Relapse prevention -? Aversive smoking +? Poor quality studies Enhancing partner support Competitions and incentives - Short-term benefits only

Conclusions Clear evidence that behavioural support can be effective delivered through a variety of modalities by a variety of providers with variety of target populations but no clear evidence on how to improve on basic behavioural support Need to build on this with innovative approaches and evaluation methods Requires: detailed information about intervention elements taxonomy of intervention elements and link with theories