BackgroundCervical cancer screening in general practice could be a routine and opportune moment to advise females who smoke to stop smoking.AimThe aims of this study were to investigate the attitudes of females who smoke to receiving advice about stopping smoking after cervical screening and to identify factors associated with the acceptability of this advice.Design and settingThis qualitative interview study was conducted with Dutch females who smoked, had undergone cervical screening, and were aged 30 to 60 years. Interviews were performed between December 2016 and September 2017.MethodIn this study 15 participants were interviewed and transcripts were analysed using thematic analysis.ResultsFemales who smoke were ambivalent (positive or sceptical) about being advised to stop smoking after they had undergone cervical screening. An explanation of why smoking behaviour is addressed by the practice assistant performing the smear, and making females feel at ease during the smear test, were found to be factors that might influence acceptability of such advice. Although a personal and non-judgemental approach to discussing smoking was considered essential, participants expressed different preferences regarding the form and content of cessation support. This was reflected by the variations in knowledge about smoking cessation support, previous experiences of cessation attempts, and received cessation advice or support.ConclusionStudy participants had mixed opinions about being given advice about smoking cessation after their cervical smear test and differed in their preferences for the type of support for smoking cessation. An interactive approach might improve how well a smoking cessation intervention is received by females who smoke and cater to their individual needs and preferences.

Background Cervical screening could be an appropriate moment to provide female smokers with stopping smoking advice and support. In Dutch general practice cervical smears are performed by practice assistants. The aim of this study was to identify potential barriers or enablers for a stopping smoking strategy performed by trained practice assistants after routine cervical screening. The strategy consists of brief stopping smoking advice and is based on the Ask-Advise-Connect approach.Methods Three focus group meetings were held with 10 practice assistants, 3 nurses, and 6 general practitioners. We analysed data using thematic analysis. Identified factors are presented within the framework of the Social Ecological Model.Results Potential influential factors were identified at individual, interpersonal, and workplace levels. At the individual level: practice assistants did not see themselves as having a professional role in a smoking cessation program. While they could register smoking status, they were reluctant to provide advice. However, practice assistants valued having advice at hand in order to make relatively young female smokers aware of the health risks At the interpersonal level: practice assistants thought that their relationship with the women would change if they gave stopping smoking advice. Moreover, the assistant’s own attitude to smokers and her beliefs about the smoker’s willingness to change behaviour could influence the relationship. At the workplace level: the availability and motivation of nurses might hamper referral. The general practitioners’ opinion about primary prevention and smoking cessation could influence the amount of support given to practice assistants when it comes to providing stopping smoking advice.Conclusions At individual, interpersonal, and workplace levels, several factors could influence the provision of a stop smoking strategy by a practice assistant. These factors could be used to design a behavioural change intervention to be provided by practice assistants after cervical cancer screening.

IntroductionCervical cancer screening in general practice could be a routine moment to provide female smokers with stop smoking advice and support. The aim of this study is to assess the effect of a stop smoking strategy delivered by trained practice assistants after the cervical smear, and to evaluate the implementation process.Methods and analysisThe study is a two-arm, pragmatic cluster randomised trial, in Dutch general practice. Randomisation takes place 1:1 at the level of the general practice. Practices either deliver the SUCCESS stop smoking strategy or the usual care condition. The strategy consists of brief stop smoking advice based on the Ask-Advise-Connect method and is conducted by trained practice assistants after routine cervical cancer screening. The primary outcome is the performance of a serious quit attempt in the 6 months after screening. Secondary outcomes are 7-day point prevalence abstinence, reduction in the number of cigarettes per day and transition in motivation to quit smoking. Follow-up for these measurements takes place after 6 months. Analysis on the primary outcome aims to detect a 10% difference between treatment arms (0.80 power, p=0.05, using a one-sided test), and will be performed according to the intention to treat principle. The process evaluation will assess feasibility, acceptability and barriers or enablers to the strategy’s implementation. For this purpose, both qualitative and quantitative data will be collected via questionnaires and in-depth interviews, respectively, in both individual study participants and involved staff.Ethics and disseminationThe Dutch Ministry of Health, Welfare and Sport approved of the trial after an advisory report from the Health Council (Nr. 2018/17). A licence was provided to conduct the study under the Population Screening Act. Study results will be disseminated through publications in peer-reviewed journals and conference presentations.Trial registration numberNL5052 (NTR7451).

Background Cervical screening could be an appropriate routine moment to provide female smokers with tailored stop smoking advice. In Dutch general practice, cervical smears are performed by practice assistants. Objectives This study was performed in preparation for a randomised trial to identify potential barriers and enablers for a brief stop smoking strategy performed by trained practice assistants after routine cervical screening. Methods Between December 2016 and March 2017 three focus group meetings were held with ten practice assistants, three nurses, and six general practitioners to explore their views and expectations towards the proposed approach. We analysed data using thematic analysis. Identified factors are presented within the framework of the Social-Ecological Model. Results Potential barriers and enablers were identified at individual, interpersonal, and workplace levels. Practice assistants, nurses and GPs did not consider assistants to have a role in stop smoking care. They believed it is feasible to register smoking status but had reservations towards providing advice by assistants, for which knowledge and skills are needed. Practice assistants’ own beliefs about smokers and smokers’ response to stop smoking advice might influence how assistants and smokers interact. An explanation of why advice is given could help, provided assistants have enough time and experience with the smear. The nurses’ availability and general practitioners’ view on prevention might affect the delivery of the strategy by the assistant. Conclusion At individual, interpersonal, and workplace levels, several factors could influence the provision of a stop smoking strategy by a practice assistant.

The authors have withdrawn this preprint due to author disagreement.