Telephone counseling and related intervention features such as social support provided through interventions have been found effective in smoking cessation. However, related to more general needs for understanding how social support influences behavior and contributes to health promotion interventions, an important question concerns the relative effectiveness of (a) protocol driven, standardized and/or Directive approaches to intervention delivery versus (b) person-centered, flexible, and/or Nondirective approaches. This project will examine the implementation, reach, efficacy, and likelihood of adoption of two approaches to telephone counseling for smoking cessation: Standardized Intervention and Flexible Nondirective Intervention. Employees of BJC HealthCare responding to announcements of the availability of free telephone counseling for smoking cessation will be randomized to Standardized Intervention - 7 calls in which callers will ascertain progress of the quitter and, according to predetermined protocols, provide encouragement and advice appropriate to the quitter's readiness to quit, or Flexible, Nondirective Intervention - 7 calls in which callers will inquire as to general issues and interests of the quitter in a manner intended to be pleasant and express nonintrusive interest in the quitter, inquire as to quitter's perception of their progress and areas in which they need help, reflect and endorse the quitter's perception of progress made. Both interventions will address Key Steps in Smoking Cessation (e.g., setting a quit date) supported by major reviews and individual research studies. Because smoking and burdens of smoking-related disease are increasingly economically stratified and disproportionate among underserved minority groups, promotional and recruitment efforts will place special emphasis on encouraging participation among low income, nonprofessional health care workers. Borrowing from the RE-AIM model, evaluation will include reach to and retention of potential participants, especially low income, nonprofessional health care workers, as well as outcomes in terms of abstinence and indicators of key variables in determining outcomes. The principal outcome will be reported abstinence (no smoking or use of other tobacco or nicotine products) for at least 1 month. Analyses will also examine roles of potential mediators or moderators of interventions, including smoking history, self efficacy, social support, pros/cons of smoking. Power will range from .66 to .99 depending on recruitment rates (projected to range from 15% to 25%) and the magnitude of difference in outcomes between the two conditions.
| Sumner 2nd, Walton; Walker, Mark S; Highstein, Gabrielle R et al. (2016) A randomized controlled trial of directive and nondirective smoking cessation coaching through an employee quitline. BMC Public Health 16:550 |
| Fisher, Edwin B (2008) The importance of context in understanding behavior and promoting health. Ann Behav Med 35:3-18 |
