Barriers and facilitators to implementing the CURE stop smoking project: a qualitative study

Abstract

Background The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals’ implementation behaviour within the pilot site. Methods Individual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development. Results Eight TDF domains were identified as important areas influencing CURE implementation; ‘environmental context and resources’ (physical opportunity), ‘social influence’ (social opportunity), ‘goals’, ‘professional role and identity’ and ‘beliefs about consequences’ (reflective motivation), ‘reinforcement’ (automatic motivation), ‘skills’ and ‘knowledge’ (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of ‘beliefs about consequences’ and ‘knowledge’, which were highlighted as facilitators of CURE. Participants suggested that ‘environmental context and resources’ was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context. Conclusions This qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts.

Understanding the implementation strategy of a secondary care tobacco addiction treatment pathway (the CURE project) in England: a strategic behavioural analysis

“…We have also illustrated how theory can be used to optimise the implementation strategy of the CURE project. From interviews with healthcare professionals, six themes were identified as influences for the implementation of CURE 22. These were used to identify gaps in the existing implementation strategy and informed recommendations for refinement.…”

“…In line with previous research,19 27 the following mapping exercise was conducted in order to explore the extent to which barriers and facilitators of CURE implementation22 were addressed by existing implementation strategy components, and to identify any missed opportunities for further design:…”

“…A concurrent qualitative study22 reported eight key TDF domains that influenced CURE implementation (see online supplemental file 1 for a summary of these findings). To identify key domains influencing the implementation of CURE, we ranked these previously reported TDF/COM-B domains using established criteria: frequency (number of transcripts in which a domain occurred), elaboration (number of themes within a domain) and evidence of conflicting statements within domains (eg, if some participants report lack of specific skills whereas others report having the relevant skills) 28–30.…”

“…This work is a first step in designing a successful theoretical-informed implementation strategy for wider, national roll-out. This work was conducted alongside a TDF-based, qualitative study which explored the barriers and facilitators of CURE implementation and delivery, from the perspective of healthcare professionals engaged in the project pilot 22…”

Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend

“…Indeed, the ability to provide tailored, multimodal cessation interventions has been shown to potentially support smoking cessation among older individuals who smoke, from deprived backgrounds, many of whom may be eligible for lung cancer screening. 64 The ability to be flexible has also been identified as an important facilitator of successful implementation of smoking cessation services within hospitals, 65 and appears to also be important within a lung cancer screening context. However, the setup and commissioning of UK smoking cessation services within public health (where each local authority commissions its own cessation services) may limit the scope of what lung cancer screening services are able to offer.…”