Maria Duaso

Internet-delivered self-management support for improving coronary heart disease and self-management–related outcomes: a systematic review

Introduction: Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access. Objective: The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness. Method: Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase). Results: Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used. Conclusion: More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions.

Understanding how a smoking cessation intervention changes beliefs, self-efficacy, and intention to quit: a secondary analysis of a pragmatic randomized controlled trial

Although beliefs, self-efficacy, and intention to quit have been identified as proximal predictors of initiation or quitting in young adults, few studies have studied how these variables change after a smoking cessation intervention. To evaluate the changes in the beliefs, self-efficacy, and intention to avoid smoking and determine if these are potential mediators in quitting, following a smoking cessation intervention, aimed at tobacco-dependent college students. Single-blind, pragmatic randomized controlled trial with a 6-month follow-up. A total of 255 smoker students were recruited from September 2013 to February 2014. Participants were randomly assigned to intervention group (n = 133) or to control group (n = 122). The students in the intervention group received a multicomponent intervention based on the Theory of Triadic Influence (TTI). The strategies of this program consisted of a 50 min motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. The smoking-related self-efficacy, belief, and intention scale was used to assess outcomes. Intention to quit smoking is partial moderator explaining 36.2% of the total effects in smoking cessation incidence. At 6 month follow-up, the differences in the mean scores of self-efficacy and intention related to stopping smoking were significantly higher in the intervention than in the control group. A multicomponent intervention based on the TTI, tailored to college students, positively increased the self-efficacy to avoid smoking and the intention to quit, suggesting intention as potential mediator of quitting.

Missed opportunities: a qualitative study of views and experiences of smoking cessation amongst adults in substance misuse treatment

Abstract Background: Smoking rates amongst people with a substance use disorder are disproportionately high. This study aimed to explore views and experiences of smoking and smoking cessation amongst people in substance misuse treatment in order to uncover novel perspectives which could assist in addressing this disparity. Methods: A qualitative research design was employed, using individual semi-structured interviews. The sample comprised 15 smokers and ex-smokers with a history of drug misuse who were recruited from four inner city substance misuse services. Interviews were audio recorded and analysed using the Framework method. Results: Several themes were uncovered, including the influence of the environment, peers and staff on motivation to quit and quit attempts; a complex link between smoking and substance use and the impact of substance misuse treatment experiences on attitudes towards smoking cessation. A number of missed opportunities were revealed, as well as unique factors affecting access to smoking cessation treatment for this population, demonstrating support for provision of smoking cessation treatment within both generic and specialist health services. Conclusions: People accessing substance misuse treatment seek to apply their learning from quitting illicit substances to smoking cessation. However, despite the availability of smoking cessation treatment including pharmacotherapy within substance misuse services and interest from service users, quit attempts were not encouraged or supported by substance misuse staff. Opportunities to quit within such services are minimal, inconsistent and not aligned or sustained across services.