1. UTILIZING TELEPHONE INTERVIEWERS AS COUNSELORS: LESSONS LEARNED FROM A SMOKING REDUCTION STUDY Bridget Gaglio, MPH 1, Tammy Smith, BS 2, Erica Ferro, MA 1, Russell E. Glasgow, PhD 1 1 Kaiser Permanente Colorado - Institute for Health Research 2 AMC Cancer Research Center Denver, Colorado Denver, Colorado

2. Purpose of Presentation Overview of study for context Overview of study for context Focus on counseling call intervention component Focus on counseling call intervention component 3-month study results 3-month study results Feasibility and lessons learned from implementing tailored telephone “counseling calls” with data collection interviewers Feasibility and lessons learned from implementing tailored telephone “counseling calls” with data collection interviewers

3. THE SMOKING LESS, LIVING MORE STUDY Behavioral - Smoking reduction study Randomized Trial Randomized Trial KPCO members scheduled for an outpatient procedure or diagnostic procedure KPCO members scheduled for an outpatient procedure or diagnostic procedure 18 years of age or older 18 years of age or older Smoked 10 or more cigarettes per day Smoked 10 or more cigarettes per day Intervention delivered over a 6-month period of time with a 12-month follow-up Intervention delivered over a 6-month period of time with a 12-month follow-up

4. Tailored Interviews Consisted of assessment of participants’: Current level of smoking Current level of smoking Goal setting Goal setting Level of self-efficacy Level of self-efficacy Barriers and strategies Barriers and strategies Environmental support Environmental support Quit attempts Quit attempts

5. THE INTERVIEWERS 4 interviewers 4 interviewers Age range early 20s to mid-50s Age range early 20s to mid-50s No training or background in psychosocial and/or smoking cessation counseling No training or background in psychosocial and/or smoking cessation counseling Current data collection interviewers at AMC Cancer Research Center Survey Research Core Current data collection interviewers at AMC Cancer Research Center Survey Research Core

6. INTERVIEWER TRAINING Use of Computer Assisted Telephone Interviewing (CATI) system Use of Computer Assisted Telephone Interviewing (CATI) system Overview session of entire study Overview session of entire study Call-specific training for each counseling call Call-specific training for each counseling call Monitored live calls and real-time feedback for quality control and improvement Monitored live calls and real-time feedback for quality control and improvement Independent practice of scenarios not recently encountered, review of CATI call content, and to practice call scenarios using own language Independent practice of scenarios not recently encountered, review of CATI call content, and to practice call scenarios using own language

8. PARTICIPANT SATISFACTION Satisfaction results ranged from 4.2 to 4.5 5 point scale (1= not characteristic to 5= very characteristic) * “She was interested in my progress and very supportive.” * “The more often she called, the better I did with reducing and being aware of my attempts to smoke less.” * “I seem to go for a smoke right after each call.”

9. QUALITATIVE RESULTS Rapport Building Rapport Building Personalizing Personalizing Realistic Philosophy Realistic Philosophy “Making the call your own” “Making the call your own” Training provided by research staff Training provided by research staff Personal experiences, realized could draw on these without actually sharing them with client Personal experiences, realized could draw on these without actually sharing them with client Continuity of Interviewer and Research Staff Continuity of Interviewer and Research Staff

10. LESSONS LEARNED Getting interviewers out of “data collection” mind-set and in to “counseling” mind-set Getting interviewers out of “data collection” mind-set and in to “counseling” mind-set Adaptations made to assist interviewers with carrying out intervention Adaptations made to assist interviewers with carrying out intervention Need for iterative training throughout deployment of intervention Need for iterative training throughout deployment of intervention

11. CONCLUSIONS Overall, the program was well received by outpatients who were unwilling or not ready to quit smoking. Overall, the program was well received by outpatients who were unwilling or not ready to quit smoking. The program was proven feasible and successful to implement by telephone staff that had no previous counseling experience. The program was proven feasible and successful to implement by telephone staff that had no previous counseling experience. Despite their lack of prior training, data collection interviewers were able to learn and successfully employ rapport-building skills and actively engage a majority of the individuals who participated in this smoking reduction study. Despite their lack of prior training, data collection interviewers were able to learn and successfully employ rapport-building skills and actively engage a majority of the individuals who participated in this smoking reduction study.

12. ACKNOWLEDGEMENTS The interviewers from AMC Cancer Research Center The interviewers from AMC Cancer Research Center The study participants The study participants NCI for funding this study NCI for funding this study My colleagues in Denver: Drs. Russell Glasgow, Debra Ritzwoller, Paul Estabrooks, Arnold Levinson, Al Marcus and Tammy Smith, Erica Ferro, Holly Whitesides, Allison Edwards, Dan Winn, Anna Sukhanova My colleagues in Denver: Drs. Russell Glasgow, Debra Ritzwoller, Paul Estabrooks, Arnold Levinson, Al Marcus and Tammy Smith, Erica Ferro, Holly Whitesides, Allison Edwards, Dan Winn, Anna Sukhanova

14. Overview of the Intervention Components 2 nd Follow-Up Telephone Counseling Call (3 weeks after procedure) 3rd Tailored Newsletter (5 weeks after procedure) 3-month assessment and sample collection 4 th Tailored Newsletter (5 weeks after procedure) 3 rd & Final Follow-Up Telephone Counseling Call (14 weeks after procedure) Baseline Sample Collection 1 st Tailored Newsletter (3-5 days before procedure) Recruitment and Baseline Call – Telephone Counseling Interview (10-15 days before procedure) 2 nd Tailored Newsletter (10-14 days after procedure) 1 st Follow-Up Telephone Counseling Call (2-3 days after procedure)

15. KEY Purple – all participants Green – didn’t achieve 1/3 reduction, 2 nd failure Blue – achieved first 1/3 reduction, 1 st success Pink – didn’t achieve 2/3 reduction, 1 st failure Yellow – achieved 2/3 reduction, 2 nd success Dashed line – depends on response Introduction Screen Newsletter Follow-up Screen First Self-Efficacy Screen Reassessment of Cigarettes Per Day Screen Congratulations Screen (achieved 1/3 reduction, 1 st success) Did You Try To Reduce Smoking by 2/3? Screen (didn’t achieve 1/3 reduction, 2 nd failure) Review High Risk Situations Screen Review 3 Main Reduction Strategies Screen (all but achieved 2/3 reduction group) Goal Setting For 1 st Success Screen Goal Setting For 1 st Failure Screen Second Level Enabling/ Implementation Strategies Screen, (Optional for 1 st success & 2 nd failure groups) Non-Approved Strategies Response Pop-Up Screens Thank You and Exit Screen General Questions Pop-Up Screens Next Options Screen (achieved 2/3 reduction, 2 nd success) Did You Try To Reduce Smoking by 1/3? Screen (didn’t achieve, 2 nd failure) Initial Type of Smoker Screen Goal Setting for 2 nd Failure Screen Summary Screen Cessation Screen Further Reduction: goal setting screen Maintenance Screen Cessation Strategies Screen Relapse Prevention Screen Further Reduction: Strategies Screen Further Reduction: 2 nd level enabling strategies screen Drop Study Screen (Only those who want to drop) Reschedule Screen