1 What role can technology play in tobacco dependence treatment? University College London November 2012 Robert West

How can technology be used? Training, assessing and supporting health professionalsChannels for health professional support to smokersAutomated support for smokers 2

The COM-B model of behaviour 3 Michie et al 2011 Implementation Sci have the physical and psychological capability have the physical and social opportunity be more motivated to do it at the relevant time than anything else For any behaviour to occur the individual or group must

Behaviour change framework for aiding smoking cessation 4 Build capacity for self-regulation Help understand benefits of cessation Inform about best ways of quitting Build capacity for self-regulation Help understand benefits of cessation Inform about best ways of quitting Persuade that quitting is worthwhile Foster desire to quit Tackle urges to smoke Persuade that quitting is worthwhile Foster desire to quit Tackle urges to smoke Provide easy access to support Minimise exposure to smoking cues Develop norms around quitting Provide easy access to support Minimise exposure to smoking cues Develop norms around quitting

The process of stopping smoking Decide on the ‘quit smoking rule’ Decide on the ‘quit point’ Lay the ground work Get ready Apply the quit smoking rule Go Do whatever is necessary stick to the rule Keep going 5

The battle of will ‘in the moment’ 6 I will not  will smoke Smoking would be bad  good Want/need to not smoke  smoke Want/need to not smoke  smoke Inhibition/urge not smoke  smoke Inhibition/urge not smoke  smoke Non-smoker identity Mental energy Reasons not to smoke Sources of desire not to smoke Ability to inhibit responding Reasons to smoke Sources of desire to smoke Sources of smoking urges

The battle over time and where interventions fit it 7 Time Intervention

Automated support Websites Text messaging Smartphone apps 8

Text2Stop 9

Potential reach of websites and apps 10

Smoking cessation websites 11 Civljak 2010 Cochrane Reviews

Industry-sponsored sites 12 Based on Click2Quit Based on Happy Endings

StopAdvisor 13

Transparent development process 14

StopAdvisor pilot study 15 Recruited 204 smokers Mean pages viewed in 6.6 log-ins No social gradient 20% CO-verified abstinence >4weeks

MumsQuit 16

SF28 17

Characteristics of SF28 users 18

Characteristics of SF28 users 19

Reported usage and outcomes 20

New channels for delivery of support 21 Video-based smoking cessation support

Behaviour change framework for stop- smoking support 22 Develop knowledge and understanding Build skills Provide CPD Develop knowledge and understanding Build skills Provide CPD Persuade that support is worthwhile Assess and reward competence Build and maintain morale Persuade that support is worthwhile Assess and reward competence Build and maintain morale Provide prompts and cues Provide ready access to resources Provide additional comms channels Provide prompts and cues Provide ready access to resources Provide additional comms channels

National Centre for Smoking Cessation and Training 23 Training, assessment and certification Continuing Professional Development and resources

Basic training of Stop-Smoking Practitioners 24

NCSCT accreditation 25

Effect of NCTCS online training 26

Very brief advice training 27

Key points automate behavioural support for smokers provide channels of communication for behavioural support contribute to training, assessment, CPD of practitioners act as a tool for practitioners Technology has the potential to websites for smokers text messaging for smokers knowledge training for practitioners Some evidence for effectiveness of 28