Camille Alexis-Garsee

Factors predicting recruitment to a UK wide primary care smoking cessation study (the ESCAPE trial)

BACKGROUND Recruiting smokers to smoking cessation trials is challenging and participation rates are often low. Consequently, the interventions evaluated may fail to reach a broad spectrum of the target population, thus compromising the generalizability of the findings. Brief interventions, using proactive recruitment, are likely to attract a broader and more representative proportion of the population. OBJECTIVE We explored the factors that influenced recruitment into a trial evaluating computer-tailored feedback reports that aimed to help smokers to quit [the ESCAPE (Effectiveness of computer-tailored Smoking Cessation Advice in Primary Care) study] in order to investigate the possibilities for increasing recruitment into smoking cessation trials. METHODS Current cigarette smokers, identified from GP records, were invited to participate in the study. The main outcome measure was the recruitment rate, i.e. the proportion of participants who responded and were randomized to one of the intervention groups. Predictor variables included geographical region, level of deprivation, practice characteristics and the number and timing of mailings of questionnaires. RESULTS The recruitment rate varied by practice (2.5-19.8%) and differed significantly between regions (from 16.3% in Scotland to 8.4% in London, P < 0.001). Recruitment decreased significantly by 1.1% between the lowest and highest quintiles of deprivation (P = 0.012), measured by Index of Multiple Deprivation scores, and decreased by 1.33% for every extra 10% smokers identified within a practice population (P = 0.010). Sending reminders increased recruitment by 7.5% (P < 0.001). Multivariable analysis showed region and length of time between mailings were the main predictors of recruitment. CONCLUSIONS Proactive recruitment methods can increase participation in smoking cessation trials and weighting the target sample in favour of more deprived areas will recruit a more representative sample. The number and timing of mailings to potential participants can also increase recruitment.

ESCAPE: a randomised controlled trial of computer-tailored smoking cessation advice in primary care.

AIMS To evaluate the effectiveness of tailored cessation advice reports, including levels of reading ability, compared with a generic self-help booklet. DESIGN Participants were randomised to receive standard non-tailored information or to receive standard information plus a cessation advice report and a progress report, both tailored to individual characteristics. SETTING One hundred and twenty-three general practices located throughout the UK. PARTICIPANTS Questionnaires were mailed to 58 660 current cigarette smokers aged 18-65 years, identified from general practitioner records. Of the 6911 (11.8%) who completed the questionnaire, provided consent and were enrolled into the study, 6697 (11.4%) were included in the analysis. MEASUREMENTS Follow-up was by postal questionnaire sent six months after randomisation, or by telephone interview for participants failing to return the questionnaire. The primary outcome was self-reported prolonged abstinence for at least three months at the six-month follow-up. FINDINGS Quit rates on the primary outcome were not significantly different (3.2% versus 2.7%) (OR = 1.20, 95% CI [0.94, 1.54], P = 0.15). A significantly higher proportion of intervention group participants made a quit attempt during the follow-up period (32.3% versus 29.6%; OR = 1.13, 95% CI [1.01, 1.26], P = 0.026). CONCLUSION ESCAPE, a brief tailored smoking cessation intervention delivered by post and designed to reach a wide population of smokers, appears to increase the rate at which smokers try to stop, but if there is an effect on prolonged abstinence it is small.

Characteristics of a population-wide sample of smokers recruited proactively for the ESCAPE trial.

OBJECTIVES To describe the characteristics of a sample of smokers recruited proactively into a smoking cessation trial, and to compare these characteristics with the wider population using data from the General Household Survey (GHS) and National Statistics Omnibus Survey. STUDY DESIGN Sample recruited for a randomized controlled trial. METHODS Between August 2007 and October 2008, 123 general practices mailed questionnaires to smokers in the U.K. identified from computer records. Smokers willing to participate in a trial of personalized computer-tailored feedback returned the questionnaires to the research team. The characteristics of the sample were compared with the wider population using data from the GHS and National Statistics Omnibus Survey, and Index of Material Deprivation scores. RESULTS A response rate of 11.4% (n = 6697) was achieved. The sample was demographically similar to the population sample, with an even distribution of participants from areas of both high and low deprivation. The sample was more dependent than the GHS sample, but less dependent than clinic samples. Distribution by motivation and readiness to quit was similar to population estimates. CONCLUSIONS Public health strategies targeting the entire population of smokers are needed to counter the low recruitment rates resulting from the traditional reactive methods of recruitment to smoking cessation studies. Using computerized records to identify and contact patients who are smokers is a simple method of recruiting a larger, more representative sample of smokers.

An exploration of health-seeking behaviours among Nigerian Christians in the UK: towards enhanced health services utilisation

ABSTRACT Migration from different cultures carries with it some acclimatisation challenges. This study explored various health-seeking behaviours and potential barriers to healthcare utilisation among Nigerian Christians in the UK. This qualitative study involved 10 adult male and female participants, with both interviews and focus group discussion (FG) for data collection (Interviews: n = 4, FG: n = 6). Thematic analysis revealed that religious and cultural beliefs were barriers to healthcare utilisation. The implication is that further research on cultural matching between care providers and service users is needed; where religious leaders and health providers from Nigeria can influence health decisions among this migrant community. Limitations of the current study are discussed, with directions for further research identified.

Prevalence of somatisation as a determinant of burnout amongst staff working in drug and alcohol services

Purpose The purpose of this paper is to explore the prevalence of somatisation as a determinant of burnout amongst drug and alcohol staff in the UK. Design/methodology/approach The study employed a cross-sectional design utilising a self-completion online questionnaire. Data were collected from substance misuse workers across England and Wales. In total, 165 responses were eligible for analysis, yielding a response rate of 5 per cent. Burnout and somatization were measured with Maslach’s Burnout Inventory and the Physical Symptoms Inventory. Findings The prevalence of somatic symptoms was relatively low in the sample studied. The reported levels of burnout were moderate. Personal accomplishment remained high in the sample. There was a strong association between burnout and incidence of stress-related somatic symptoms, with higher levels of burnout correlating with multiple symptoms. Research limitations/implications It was not possible to determine the extent of non-response bias, as at the time of the study there was no information available relating to the characteristics of drug and alcohol staff in the selected services. Therefore, as the response rate was very low (5 per cent) it was recognised that non-response bias might have affected the findings, in such way that non-respondents may have differed in their experiences of work stress, satisfaction, burnout and health outcomes. Practical implications Despite the limitations, the study provided practical information relating to burnout vulnerability and associated physical symptoms in this specific occupational group. These findings can support employers to address staff wellbeing with a view to prevent burnout and reduce existing levels of burnout and related somatic symptoms, and improve job performance, job satisfaction and staff retention through making appropriate adjustments, such as developing staff-wellbeing programmes. These adjustments could potentially contribute to improvement in substance misuse practice, through maintenance of healthy and satisfied workforce. Originality/value There are very few studies looking at burnout in drug and alcohol staff. This study is also novel in a way that it reveals correlations between a variety of specific stress-related physical symptoms and the three components of burnout.

Nigerian Clergy and healthcare professionals’ perceptions of health-seeking behaviours among Nigerian immigrants in the UK

ABSTRACT The diversity in patient populations due to immigration in the UK has implications for adequate understanding of a patients’ culture by the clinician as well as patient–clinician cultural matching for enhanced service use and outcome. This qualitative study investigated how Nigerian clergy and health professionals perceived health-seeking behaviours among Nigerians in the UK, while considering the impact of their own beliefs and values as care providers. Six participants were interviewed (clergy, n = 2; health professionals, n = 4). Data were analysed using Interpretative Phenomenological Analysis. Results showed that the clergy and health professionals themselves use religious/cultural cure and formal healthcare methods, and believed Nigerian immigrants as predominantly using religious/cultural methods which can affect healthcare utilisation, although differences between the professionals were reported. The potentials for integrating other cure methods into the formal healthcare services were considered, while highlighting the challenges that may arise from such collaborative effort.