What do clients think about NHS stop smoking services? A client satisfaction survey Fiona Dobbie, Rosemary Hiscock, Linda Bauld

Outline Background to the survey Sample, analysis and caveats around interpretation Findings: Overall level of satisfaction Making initial contact Appointment time and venue Service received Medication Conclusions/ points for discussion

Background to the survey Designed in 2008 as part of the Department of Health’s monitoring and evaluation guidance for SSS Survey purpose is to assess levels of satisfaction with the SSS Survey is self-complete and there is no requirement for SSS to actively use it Was included as part of larger study (ELONS) looking at longer term outcomes for clients who use NHS SSS Included as an incentive to encourage services to become recruitment sites for ELONS Research team did not plan to administer the CSS

Background to the survey All clients who agreed to take part in ELONS (n=3075) were sent a CSS (regardless of their quit attempt outcome) Two reminder mailings and prize draw to encourage response 1006 questionnaires were received and the final dataset had 996 cases = 33% response rate Questionnaires were entered into excel and then transferred to SPSS for analysis

Analysis – 3 phases 1) Descriptive frequencies for each satisfaction variable 2) Crosstabs with ELONS study information: 1) Quitters compared with non quitters 2) Behavioural support types compared 3) Free text comments added to augment findings

CSS sample characteristics

Recruited to ELONS Responded to client satisfaction survey N%N% Total Smoking status CO validated quit Not CO validated quit Self-report quit Not self-report quit Gender Male Female Age groups

Key findings

Overall levels of satisfaction 87% satisfied or very satisfied 87% satisfied or very satisfied 96% would recommend SSS 96% would recommend SSS 96% would return to the SSS if needed 96% would return to the SSS if needed 86% believed they would be welcomed back 86% believed they would be welcomed back

Subgroup differences Quitters more likely to Quitters more likely to Be satisfied/very satisfied (88% vs 84% p=.001) Be satisfied/very satisfied (88% vs 84% p=.001) Believe they would return (96% vs 89% p<.001) Believe they would return (96% vs 89% p<.001) Believe they would be welcomed back Believe they would be welcomed back (88% vs 79% p<.001) (88% vs 79% p<.001) Belief they would be welcomed back differed significantly by behavioural support (p=.011) Belief they would be welcomed back differed significantly by behavioural support (p=.011) Open groups were more likely to say they would be welcomed back (92%) than other (pharmacy, closed group, unclassified) (80%) Open groups were more likely to say they would be welcomed back (92%) than other (pharmacy, closed group, unclassified) (80%)

I would have struggled to stop smoking without the help of the service. I would definitely recommend anyone wishing to stop smoking to use this service. I hope to never use the service again but would not hesitate to if the requirement came about.

Making initial contact 94% agreed it was easy to contact SSS 94% agreed it was easy to contact SSS 88% given an appointment date 88% given an appointment date 93% said the length of time they had to wait was acceptable 93% said the length of time they had to wait was acceptable 60% waited 0-5 days 60% waited 0-5 days 30% waited 6-10 days 30% waited 6-10 days 10% waited >10 days 10% waited >10 days 31% had motivating contact from SSS before appointment 31% had motivating contact from SSS before appointment

Appointment time and venue 95% said the time was convenient 95% said the time was convenient 97% said the place was convenient 97% said the place was convenient 42% able to choose group or 1 to 1 (11% unsure) 42% able to choose group or 1 to 1 (11% unsure) 16% said there was no child care support 16% said there was no child care support

Appointment time and venue Free text comments also very positive but some suggestions for improvement: Free text comments also very positive but some suggestions for improvement: flexible appointment times There are no evening appointments at my local clinic, which makes things difficult for those who work full time a wider choice of behavioural support I would have preferred individual appointments to group therapy

Appointment time and venue a longer treatment period I feel that instead of having to attend for just 4 weeks it should be rolled out to at least 8. From past experience I feel 4 weeks is too quick more telephone contact to maintain morale Maybe a text or phone call between appointment time. i.e. 2 weeks is a long time to leave someone without encouragement.

Service received % responding positively % Support from staff 89 Advice and support helpful 90 Written information helpful 81 CO reading helpful86 Note 7% reported that they did not receive written information 6% reported that they did not have their CO taken every visit

Which subgroups were more likely to think staff were supportive? Varied by whether quit (p<.001) Varied by whether quit (p<.001) 91% quitters 91% quitters 85% non quitters 85% non quitters Varied by behavioural support P=.014 Varied by behavioural support P=.014 Open group 94% Open group 94% Drop in 92% Drop in 92% One to one specialist 86% One to one specialist 86% GP practice 86% GP practice 86% Other 85% Other 85%

Advisors– free text comments Client/advisor rapport and advisor continuity important Client/advisor rapport and advisor continuity important [Name of advisor] was the best person for the job, she was dead easy to talk to about anything but the woman who took over from her made me feel really unsettled in a telephone consultation therefore never went back!!! It would be helpful to see the same person every week. Sometimes I saw different people and had to keep introducing myself and explaining how long I'd given up etc.

Medication Source of medication GP prescription 50 Chemist (bought myself) 3 Chemist (with a voucher) 14 Chemist (with service letter or prescription) 18 Stop smoking service % thought medication information was helpful 94 % thought medication information was helpful 96% quitters & 89% non quitters (p<.001) 96% quitters & 89% non quitters (p<.001) 92% thought it was easy to access 92% thought it was easy to access

Medication – free text comments lack of information on the side-effects of medication Side effects of champix need to be highlighted - include info on all possible side effects.

Medication – free text comments difficulty obtaining medication It would be better if stop smoking staff could give out medication as I had to make three trips with letters, prescriptions etc. to finally get medication 5 days later. Chemist don’t carry enough stock! Most weeks I have to wait for some. Normally next day + costs of travel again.

Conclusions Consistent pattern pointing to a very positive experience Consistent pattern pointing to a very positive experience Examples of good practice beyond DH requirements Examples of good practice beyond DH requirements Free text highlighted the importance of client/advisor rapport Free text highlighted the importance of client/advisor rapport Quitters more likely to report higher levels of satisfaction than non –quitters Quitters more likely to report higher levels of satisfaction than non –quitters CSS not widely or consistently used by SSS CSS not widely or consistently used by SSS

Acknowledgements Study TeamStop Smoking Service recruitment sites Linda Bauld Leonie Brose Paul Aveyard Tim Coleman Fiona Dobbie Carol Anne Greenan Rosemary Hiscock Maureen Kennedy Jo Leonardi-Bee Andy McEwen Hayden McRobbie Susan Murray Richard Purves Lion Shahab Sarah Simm Bristol County Durham and Darlington Hull and East Riding Leicestershire County and Rutland Oldham Northamptonshire North East and North Lincolnshire Rotherham South East Essex

Acknowledgements Funders: This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 09/161/101) and will be published in full in Health Technology Assessment. Funders: This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 09/161/101) and will be published in full in Health Technology Assessment. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. UK Centre for Tobacco and Alcohol Studies, North51, National Centre for Smoking Cessation and Training, NHS Stop Smoking Services, PCRN/CLRN UK Centre for Tobacco and Alcohol Studies, North51, National Centre for Smoking Cessation and Training, NHS Stop Smoking Services, PCRN/CLRN For further information contact: Fiona Dobbie, ELONS Project Manager, School of Management, University of Stirling, Stirling FK9 4LA, Tel: , For further information contact: Fiona Dobbie, ELONS Project Manager, School of Management, University of Stirling, Stirling FK9 4LA, Tel: ,

Thank you

Recruited to ELONS Responded to client satisfaction survey N%N% Total Location Site Site Site Site Site Site Site Site Site Behavioural support type Closed group Open group Drop in One to one specialist 1, GP practice Pharmacy Other or unclear