Rivas Carol, Sohanpal Ratna, MacNeill Virginia, Steed Liz, Edwards Elizabeth, Antao Laurence, Griffiths Chris, Eldridge Sandra, Taylor Stephanie, Walton Robert
Social Science Research Unit, University College London, London, UK.
Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
BMJ Open. 2017 Oct 27;7(10):e015664. doi: 10.1136/bmjopen-2016-015664.
To determine communication strategies associated with smoking cessation in the National Health Service community pharmacy Stop Smoking programme.
11 community pharmacies in three inner east London boroughs.
9 stop smoking advisers and 16 pairs of smokers who either quit or did not quit at 4 weeks, matched on gender, ethnicity, age and smoking intensity.
1-3 audio-recorded consultations between an adviser and each pair member over 5-6 weeks were analysed using a mixed-method approach. First a content analysis was based on deductive coding drawn from a theme-oriented discourse analysis approach and the Roter Interaction Analysis System. Core themes were identified through this quantification to explore in detail the qualitative differences and similarities between quitters and non-quitters.
Quantitative analysis revealed advisers used a core set of counselling strategies that privileged the 'voice of medicine' and often omitted explicit motivational interviewing. Smokers tended to quit when these core strategies were augmented by supportive talk, clear permission for smokers to seek additional support from the adviser between consultations, encouragement for smokers to use willpower. The thematic analysis highlighted the choices made by advisers as to which strategies to adopt and the impacts on smokers. The first theme 'Negotiating the smoker-adviser relationship' referred to adviser judgements about the likelihood the smoker would quit. The second theme, 'Roles of the adviser and smoker in the quit attempt', focused on advisers' counselling strategies, while the third theme, 'Smoker and adviser misalignment on reasons for smoking, relapsing and quitting', concerned inconsistencies in the implementation of National Centre for Smoking Cessation and Training recommendations.
Advisers in community pharmacies should use the advantages of their familiarity with smokers to ensure appropriate delivery of patient-centred counselling strategies and reflect on the impact on their counselling of early judgements of smoker success.
确定英国国家医疗服务体系社区药房戒烟项目中与戒烟相关的沟通策略。
伦敦东部三个行政区的11家社区药房。
9名戒烟顾问以及16对吸烟者，这些吸烟者在4周时要么成功戒烟，要么仍在吸烟，他们在性别、种族、年龄和吸烟强度方面相互匹配。
采用混合方法分析顾问与每对吸烟者在5至6周内进行的1 - 3次录音咨询。首先，基于从主题导向话语分析方法和罗特互动分析系统得出的演绎编码进行内容分析。通过这种量化确定核心主题，以详细探究戒烟者和未戒烟者之间的定性差异和相似之处。
定量分析显示，顾问使用了一套核心咨询策略，这些策略优先考虑“医学之声”，且常常省略明确的动机性访谈。当这些核心策略辅以支持性谈话、明确允许吸烟者在咨询期间向顾问寻求额外支持、鼓励吸烟者运用意志力时，吸烟者往往会戒烟。主题分析突出了顾问在采用哪些策略方面所做的选择以及对吸烟者的影响。第一个主题“协商吸烟者与顾问的关系”指的是顾问对吸烟者戒烟可能性的判断。第二个主题“顾问和吸烟者在戒烟尝试中的角色”聚焦于顾问的咨询策略，而第三个主题“吸烟者与顾问在吸烟、复吸和戒烟原因上的不一致”涉及国家戒烟与培训中心建议实施过程中的不一致情况。
社区药房的顾问应利用其对吸烟者的熟悉优势，确保以患者为中心的咨询策略得到恰当实施，并反思对吸烟者成功的早期判断对其咨询工作的影响。
