Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients' and Health Care Professionals' Perspectives.

Kristin Thomas,Marcus Bendtsen,Preben Bendtsen,Catharina Linderoth

doi:10.2196/17563

Abstract

BackgroundThere is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients.ObjectiveThis study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery.MethodsA qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data.ResultsTwo main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium.ConclusionsSmoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery.

Highlights

Smoking is responsible for more than 60 diseases and is the single-most important preventable factor for disease and premature mortality [1]
Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention
Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines

Summary

Introduction

Smoking is responsible for more than 60 diseases and is the single-most important preventable factor for disease and premature mortality [1]. The proportions are 16% for women and 13% for men. Smoking was found to be an independent risk factor exemplified by the fact that smokers needed intensive care and prolonged postoperative hospital stays to a greater extent than nonsmokers [9]. Research show that complications can be avoided even with short-term perioperative smoking cessation [10,11]. Findings in a Cochrane review, based on indirect comparisons and evidence from two small trials, show that interventions beginning 4-8 weeks before surgery and including weekly counseling were most likely to have a significant impact on complications and on long-term smoking cessation [10]. There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients

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