Project identifier:Smoking Fag Ends
Topic:Smoking cessation
Location:North West England (Liverpool and Knowsley)
Dates covered:1994–2012
Overview
A service composed entirely of lay advisers, which grew out of a self-help group comprising ex-smokers who acted as volunteers to help others quit smoking. By 1997, it had become an active arm of the Roy Castle Lung Cancer Foundation. The service then combined a telephone helpline with group and individual one-to-one counselling.
Subsequently, the service was commissioned by Liverpool Primary Care Trust (PCT) to deliver smoking cessation services. The successful model was later expanded to Knowsley, Cheshire. It represents a community-based initiative with a social, rather than medical, model.
Objectives
The intervention aimed to achieve the following behavioural goals:
l target group to use the community smoking cessation service
l target group to quit and stay quit. Theoretical model
Some aspects of the approach follow accepted theoretical or scientifically‘known’, such as the popular but highly structured Prochaska and DiClementi (1982) model and motivational interviewing, both of which are included in the add-on training that advisers can receive. However, the model as it evolved did not consciously draw on these theories, even although it reflects aspects of them.
Target population
Targeted age groups with the highest smoking prevalence: females 35–45 years and males 40–55 years. Intervention
Offers support tailored to each individual, including:
l Drop-in support: moral support and practical help at sessions at the same times every week, so that people can choose to drop in to any session whenever they want and see an advisor.
l Group sessions: led by trained advisors, these sessions are friendly, informal gatherings in familiar community settings.
l One-to-one support: private sessions with an advisor to discuss smoking habits and the sort of strategies that are likely to help.
l Telephone helpline: open Monday to Friday from 9.30 a.m. through to 8.00 p.m. to give advice, discuss strategies or just help someone through a craving (available across Merseyside).
l Text support.
Peer educator: recruitment
Staff are recruited from local communities and are therefore able to build contacts, networks and credibility.
Peer educator: training
The core of the training is a shadowing scheme through which potential advisers learn the instinctive art of the empathetic supportive and choice-centred approach (experiential learning). They also subsequently receive formal instruction through the Diploma in Smoking Cessation from the National Respiratory Training Centre, as well as a whole range of other short courses on different models and approaches to smoking cessation (propositional learning). This gives them the credibility of certification and a range of potential skills to draw on while remaining true to the original Fag Ends principles.
Advisors also receive training in motivational interviewing, group work facilitation, working one to one, presentation skills, smoking and cannabis issues, smoking and mental health issues, specific training on pharmacological interventions for smoking cessation, basic counselling skills, listening skills, and training in deaf awareness.
Evaluation
Data from the Stop Smoking Service demonstrate that the number of 4-week smoking quitters in Knowsley has increased significantly, and that targets for adult stop smoking services have been significantly exceeded.
Quantitative outcomes
In Knowsley, the number of successful 4-week quitters has increased over the life of the programme. As well as these successful quits, referral rates to the service are high.
At face value it is expensive‘per quitter’but expenditure per quitter is likely to be less than the cost of care ‘per smoker’over their life time.
Main themes and propositional statements
Peer support is more likely to be effective when it includes speaking the‘same language’.
Peer support is more likely to be credible if PSs have positive experiences of success with the condition. PSs are less likely to be distrusted or mistrusted through being perceived as a representative of‘system’. The success of peer support is not so much in the creation of social networks but more in their exploitation of, and access to, existing social networks–PSs can navigate them.
Peer support may provide an alternative‘view’of community, i.e. from within but different outcome. Peer support is more likely to be effective when it emphasises personal choice.
Building up trust takes time. PSs may have time to build up trust, whereas HPs may not have time to build up trust.
Sustainability of a peer-support service is not always attributable to continuity of membership. It may be offered by structures and clear message relating to access–offer facility to drop in.
If training allows PSs to recognise and build on their pre-existing knowledge and skills then it may increase their confidence to deliver the intervention and their sense of ownership of the intervention.
Peer-support training is more likely to be successful when it enables PSs to develop the practical skills that they will need to deliver the intervention.
When PSs have control over the intervention they are able to use their contextual/tacit knowledge (as a peer) to optimise their chances of a positive outcome.
When PSs have autonomy in the way in which they deliver the intervention they may privilege some aspects of the intervention over others, which may mean that the intervention is not as successful as it could be.
PSs will operate more effectively in a place belonging to the community, not to a health service. The environment should be‘non-health and non-institutional’.
Antecedents
None–community initiated. Descendants
None, although it has spread from Liverpool to Knowsley (see above). Cluster references
15010 Bauld L, Ferguson J, McEwen A, Hiscock R. Evaluation of a drop-in rolling–group model of support to stop smoking.Addiction2012;107:1687–95.
15011 Owens C. Increasing people’s chances of success in smoking cessation.Nurs Times2003;99:30. 15012 Owens CL. Making Stop Smoking Support More Widely Available in the Community. InThe 13th World Conference on Tobacco or Health, Washington DC, USA, 12–15 July 2006.
14492 Owens C, Springett J. The Roy Castle Fag Ends Stop Smoking Service: a successful client-led approach to smoking cessation.J Smoking Cessation2006;1:13–18.139
6251 Springett J, Owens C, Callaghan J. The challenge of combining‘lay’knowledge with
‘evidence-based’practice in health promotion: Fag Ends Smoking Cessation Service.Crit Public Health 2007;17:243–56.85
References
Bauld L, Bell K, McCullough L, Richardson L, Greaves L. The effectiveness of NHS smoking cessation services: a systematic review.J Public Health2010;31:71–82.
Prochaska JO, DiClemente, Carlo C. Transtheoretical therapy: towards a more integrative model of change.Psychother1982;19:276–88.
South J, Woodall J. Planning and Evaluating Health Promotion in Settings. In Scriven A, Hodgkins M, editors.Health Promotion Settings: Principles and Practice.London: Sage; 2011. pp. 69–86.
South J, Meah A, Branney PE.‘Think differently and be prepared to demonstrate trust’: findings from public hearings, England, on supporting lay people in public health roles.Health Promot Int