1. Evidence from reviews of behavioural interventions
Robert West
University College London
September 2008

2. Aims To review the effectiveness of behavioural support
modalities
providers
content
target populations
To consider implications for future research

3. Behavioural support Advice, encouragement and activities designed to:
maximise motivation to maintain abstinence
e.g. using anticipated praise and shame; fostering sense of achievement
minimise motivation to smoke
e.g. advising on stress reduction, avoiding high-risk situations
improve medication adherence
e.g. explaining mechanism of action
enhance self-regulatory skills and capacity
e.g. teaching strategies for resisting urges
in smokers seeking help with stopping

4. Cochrane reviews on behavioural support
Modes of delivery
One-to-one face-to-face
Group face to-face
Telephone
Types of provider
Nurses
Pharmacists
Target populations
Patient pre-operation
Hospital inpatients
Pregnant smokers
Smokers in the workplace
Intervention components
Promoting physical exercise
Hypnotherapy
Use of biomarkers
Relapse prevention
Aversive smoking
Enhancing partner support
Competitions and incentives

5. Review summaries + Good evidence for clinically significant effect
+? Evidence suggestive of a clinically significant effect
? Insufficient evidence to draw a general conclusion
-? Evidence suggestion of no clinically significant effect
Good evidence for no clinically significant effect

6. Modes of delivery Conclusion Issues One-to-one face-to-face +
No clear effect of intensity
Group face to-face
Not clearly different from one-to-one
Telephone
Mostly lacking biochem verification
Written materials +?
Small overall effect and heterogeneous

7. Types of provider Conclusion Issues Nurses +
Mixes different intervention types; advice and support during healthchecks not found to be effective
Pharmacists +?
Limited data

8. Target populations Conclusion Issues Patients before surgery +
Short-term effect
Hospitalised patients
Only in those also offered medication and support after discharge
Pregnant smokers
Appears to require dedicated specialist
Smokers in the workplace
Similar to support given in other contexts

9. Intervention components
Conclusion
Issues
Promoting physical exercise ?
Limited data
Hypnotherapy
No evidence for specific effect but heterogeneity
Use of biomarkers
Limited data: new studies not included
Relapse prevention -?
Aversive smoking +?
Poor quality studies
Enhancing partner support
Competitions and incentives -
Short-term benefits only

10. Conclusions Clear evidence that behavioural support can be effective
delivered through a variety of modalities
by a variety of providers
with variety of target populations
but no clear evidence on how to improve on basic behavioural support
Need to build on this with innovative approaches and evaluation methods
Requires:
detailed information about intervention elements
taxonomy of intervention elements and link with theories