An economic evaluation of a computer-tailored e-learning program to promote smoking cessation counseling guideline adherence among practice nurses

Ruijter, Dennis de; Hoving, Ciska; Evers, Silvia M. A. A.; Hudales, Raesita; Vries, Hein de; Smit, Eline Suzanne

doi:10.1016/j.pec.2019.07.015

Cited by 11 publications

(7 citation statements)

References 41 publications

(56 reference statements)

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“…In addition, participants' need for autonomy was assessed in the baseline questionnaire to inform message frame-tailoring. Both the questionnaire and tailored message content were based on a previously developed (cost-)effective intervention [11][12][13] and theoretically grounded in the I-Change Model [14] while (questions required for) message frame-tailoring was grounded in Self-Determination Theory (SDT) [15]. At baseline (T0), participants provided information on their smoking behaviour (e.g.…”

Section: Interventionmentioning

confidence: 99%

An economic evaluation of an online computer-tailored smoking cessation intervention that includes message frame-tailoring: A randomized controlled trial

et al. 2022

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Evidence of economic evaluations of behaviour change interventions is scarce, but needed to guide policy makers’ decision-making. This study economically evaluated 4 versions of an innovative online computer-tailored smoking cessation intervention. The economic evaluation from a societal perspective was embedded in a randomized controlled trial among 532 smokers using a 2 (message frame-tailoring, i.e. how messages are presented: autonomy-supportive vs controlling) x 2 (content-tailoring, i.e. what content is presented: tailored vs. generic) design. Both kinds of tailoring, content-tailoring and message frame-tailoring, were based on a set of questions asked at baseline. Self-reported costs, prolonged smoking abstinence (cost-effectiveness) and quality of life (cost-utility) were assessed during a 6-month-follow-up. For cost-effectiveness analysis, costs per abstinent smoker were calculated. For cost-utility analysis, costs per QALY (i.e. quality-adjusted life year) gained were calculated. A willingness-to-pay (WTP) threshold of €20.000 was used. Bootstrapping and sensitivity analysis were conducted. Cost-effectiveness analysis showed that up to a WTP of €2.000, the combination of message frame- and content-tailoring dominated all study groups. From a WTP of €2.005, the content-tailored group dominated all study groups. Cost-utility analysis revealed that the combination of message frame-tailoring and content-tailoring had the highest probability of being the most efficient study group at all levels of the WTP. The combination of message frame-tailoring and content-tailoring in online smoking cessation programmes seemed to have high potential for cost-effectiveness (smoking abstinence) and cost-utility (quality of life), thus providing good value for money. Yet, when the WTP for each abstinent smoker is high (i.e., €2.005 or higher), the addition of message frame-tailoring might not be worth the effort and content-tailoring only is preferred.

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Section: Interventionmentioning

confidence: 99%

An economic evaluation of an online computer-tailored smoking cessation intervention that includes message frame-tailoring: A randomized controlled trial

et al. 2022

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“…Economic evaluation Contacts with health care professionals (plus frequency) in the past 6 months, cessation assistance utilization (plus frequency) in the past 6 months [55] Health care utilization Economic evaluation ICECAP-A [56] Quality of life Additional studies (see "Data Analysis") Decision regret scale [61] Decisional regret…”

Section: Purpose Measurements and Sources Constructsmentioning

confidence: 99%

“…Hypothesis testing, H 1c and H 3b (7-day point prevalence abstinence [52]); additional studies (see "Data Analysis") Prolonged abstinence; 7-day point prevalence abstinence; for users that did not successfully stop: type of tobacco products and amount of tobacco consumption [52] Smoking (cessation) behavior Economic evaluation iPCQ [54] Productivity loss Economic evaluation Contacts with health care professionals (plus frequency) in the past 6 months, cessation assistance utilization (plus frequency) in the past 6 months [55] Health care utilization Economic evaluation ICECAP-A [56] Quality of life Additional studies (see "Data Analysis") Decision regret scale [61] Decisional regret Process information Regarding perceived decision support Evaluation questions a N/A: not applicable.…”

Section: Decision Implementationmentioning

confidence: 99%

An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial

et al. 2020

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Background Decision aids (DAs) may be used to facilitate an autonomous, informed decision to cease smoking and promote the uptake of evidence-based cessation assistance (ie, behavioral support, nicotine replacement therapy, or prescription medication). However, knowledge is lacking regarding their effective elements and (cost-)effectiveness. Objective We describe the development process of an online DA (called “VISOR”) that helps smokers to choose evidence-based cessation assistance. Additionally, we provide a description of the protocol of an ongoing randomized controlled trial in which the DA containing an explicit value clarification method (VCM) and tailored advice is compared with a DA without an explicit VCM and tailored advice. Methods The development of “VISOR” was based on the International Patient Decision Aid Standards guidelines. Viewpoints of end users (collected through 20 interviews with smokers) and clinical and scientific experts (assessed using 2 Delphi studies with 24 scientists and 38 clinicians) were assessed regarding cessation tool decision making and preferred DA content. These findings, together with principles from the Self-Determination Theory, served as input for the development of the online DA. A first DA prototype was alpha-tested in September 2019 and beta-tested for usability in December 2019; feedback was incorporated and resulted in a final version. The final DA contains (1) an information section, (2) an optional knowledge quiz, (3) a brief smoking assessment, (4) intuitive decision, (5) intermediate advice, (6) an explicit VCM, (7) tailored advice, and (8) access information. A randomized controlled trial is currently being conducted to assess the DA’s (cost-)effectiveness compared to a DA that does not include the explicit VCM and the tailored advice; specifically, the DA’s effect on smoking abstinence, uptake of evidence-based cessation assistance, smoking abstinence mediated through uptake of evidence-based cessation assistance, and decisional conflict are investigated. Participants are randomly allocated to receive access to 1 of the 2 DAs and are asked to complete 5 questionnaires (including the baseline questionnaire) over a period of 12 months. To evaluate the effects of the DA on the outcome measures, logistic and linear regression analyses as well as mediation analyses will be carried out. An economic evaluation will be performed to assess the cost-effectiveness. Results Data regarding the effect of the VISOR DA are currently being collected, and data collection is expected to be concluded in 2021. Conclusions By making use of an iterative process that integrated different stakeholders’ perspectives (including end users), we were able to systematically design an evidence-based DA. The study will contribute to the current knowledge regarding smoking cessation DA application, the added value of explicit VCMs, and the effect of behavioral and informed decision-making outcomes. Trial Registration Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 International Registered Report Identifier (IRRID) DERR1-10.2196/21772

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“…Sample description, attrition analyses, covariate(s) in (main) analyses Age, gender, education [52] Demographics Sample description, attrition analyses Smoking status, motivation to quit, type of tobacco products, amount of tobacco consumption, amount Smoking behavior of past cessation attempts, and cessation assistance utilization in the past 6 months [52] Sample description, attrition analyses, covariate in (main) analyses Revised Fagerström Test for Nicotine Dependence (FTND-R) [53] Nicotine dependence Economic evaluation iMTA Productivity Cost Questionnaire (iPCQ) [54] Productivity loss Economic evaluation Contacts with health care professionals (plus frequency) in the past 6 months, cessation assistance Health care utilization utilization (plus frequency) in the past 6 months [55] Economic evaluation ICEpop CAPability measure for Adults (ICECAP-A) [56] Quality of life Sample description, attrition analyses, process information, covariate in (main) analyses…”

Section: Baseline (T=0): Directly Before the Decision Aidmentioning

confidence: 99%

An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial (Preprint)

Gültzow¹,

Smit²,

Hudales³

et al. 2020

Preprint

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BACKGROUND Decision aids (DAs) may be used to facilitate an autonomous, informed decision to cease smoking and promote the uptake of evidence-based cessation assistance (i.e. behavioral support, nicotine replacement therapy and/or prescription medication). However, knowledge is lacking regarding their effective elements and (cost-)effectiveness. OBJECTIVE A fully automated online DA (called ‘VISOR’) that includes both an implicit and explicit value-clarification exercise was developed that helps smokers to choose evidence-based cessation assistance. This DA will be tested in a randomized controlled trial (RCT). METHODS The development of the DA ’VISOR’ was based on the International Patient Decision Aid Standards (IPDAS) guidelines. Viewpoints of both end users (collected through 20 interviews with current smokers) and clinical & scientific experts (assessed using a Delphi study with 24 scientists and 38 clinicians) were assessed regarding cessation tool decision making and preferred DA content. These findings, together with principles from the Self-Determination Theory, served as input for the development of the online DA. A first DA prototype was alpha tested in September 2019 and beta-tested (usability) in December 2019; feedback was incorporated and resulted in a final DA version. The DA combines intuitive and deliberate decision-making processes to facilitate both decision-making styles. An RCT will be conducted to assess the DA’s (cost-)-effectiveness. Within this RCT the DA will be compared to a DA that will not include the explicit value clarification exercise. RESULTS Data regarding the effect of the VISOR DA is currently being collected, expecting conclusion in 2021. CONCLUSIONS By making use of an iterative process that integrated different stakeholders’ perspectives (including end users) we were able to systematically design an evidence-based DA. The effect of the DA on decision-making and smoking outcomes is currently being studied. CLINICALTRIAL The trial is registered in the Netherlands Trial Register (NL8270).

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An economic evaluation of a computer-tailored e-learning program to promote smoking cessation counseling guideline adherence among practice nurses

Cited by 11 publications

References 41 publications

An economic evaluation of an online computer-tailored smoking cessation intervention that includes message frame-tailoring: A randomized controlled trial

An economic evaluation of an online computer-tailored smoking cessation intervention that includes message frame-tailoring: A randomized controlled trial

An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial

An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial (Preprint)

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