Smoking cessation interventions for people living in rural and remote areas: a systematic review protocol

Abstract

IntroductionSmoking rates among people living in rural and remote areas are higher and quit rates are lower over the past 10 years compared with people living in suburban and urban areas. Higher smoking rates contribute to greater tobacco-related disease and morbidity in rural and remote areas. Physical and social isolation, greater exposure to pro-tobacco marketing, pro-tobacco social norms, and lower socioeconomic and educational levels are contributing to these higher smoking rates and lower quit rates. Smoking cessation interventions for people in rural and remote areas have been conducted, however little is known about their effectiveness or their mechanisms of action as well as the quality of such research. Behaviour change techniques (BCTs) are mechanisms of action derived from behaviour change theory, such as goal setting and reward. Improved understanding of the contribution of BCTs for smoking cessation in the rural and remote population will support future intervention development. We aim to review the literature on smoking cessation interventions for people living in rural and remote areas to inform evidence about intervention effectiveness and mechanisms of action.Methods and analysisWe will conduct a systematic review using seven scientific databases (EMBASE, MedLine, PsycINFO, CINAHL, Cochrane, Informit Health and Scopus). We will include peer-reviewed journal articles published in English that examine a smoking cessation intervention delivered to people living in rural and remote areas in the USA, Canada and Australia. We will examine outcome data relating to intervention effectiveness (eg, point prevalence abstinence or continuous abstinence), as well as the BCTs used in included interventions and their relationship with intervention outcomes. We will also assess the feasibility, acceptability and quality of research interventions of included articles, and provide graded recommendations based on the review outcomes. Data will be synthesised using narrative approaches and interpreted using content analysis.Ethics and disseminationEthics was not required for this systematic review. The results will be disseminated through peer-reviewed publication and at conferences by presentations.PROSPERO registration number177398.

An evaluation of junior doctors’ experience in smoking cessation training in a rural mental health setting

“…Given the significant health burden associated with tobacco smoking worldwide, this novel clinic in a mental health setting provides a real-world and generalizable medical education and training opportunity for junior medical staff. With higher rates of smoking and lower quit rates experienced by rural and remote residents ( 30 ), this clinic offers an option to address a health discrepancy. As people with mental illness residing in rural and remote Australia are underserviced due to a “severe shortage” of consultant psychiatrists and an inclination for trainee psychiatrists to practice in urban centers ( 53 ), the Smokers’ Clinic offers an easily implementable solution to deliver smoking cessation services to this vulnerable group in remote locations.…”

“…Whilst overall, smoking rates in Australia have declined, these findings are not proportionate across geographical locations ( 30 ). People living in rural and remote areas smoke at higher rates and quit at lower rates compared to those in urban areas ( 30 ).…”

“…Whilst overall, smoking rates in Australia have declined, these findings are not proportionate across geographical locations ( 30 ). People living in rural and remote areas smoke at higher rates and quit at lower rates compared to those in urban areas ( 30 ). Accessing community services is more difficult for rural and remote residents compared with urban residents, due to physical distance to services and social isolation.…”

“…Decreased availability of health professionals and decreased health expenditure both appear to correlate with increasing remoteness ( 33 ). Pro-tobacco social norms, lower socioeconomic and educational attainment, and different cultural attitudes are seen as significant contributing factors ( 30 ). Cumulatively, these factors may result in rural and remote residents experiencing limitations in their ability to access healthcare, maintain health beliefs that support cigarette smoking, and prevent access to smoking cessation medications and supports ( 30 ).…”

Changing patterns and prevalence of daily tobacco smoking among Australian workers: 2007–2016

“…38 Factors associated with elevated levels of risk behaviours (including daily smoking) among non-metropolitan workers include low education attainment, low income, low SES and blue-collar occupations. While higher rates of smoking in nonmetropolitan locations have been recognised for some time 39 effective cessation strategies remain an issue of current investigation, 40 with real-time video counselling 41 and other online mechanisms showing potential and effective engagement of health care workers pivotal. 39 Workers who smoke experience more general health problems and have more time off work, 5 further compounding financial disadvantage often experienced among Australians in non-metropolitan areas.…”