Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Nicotine Tob Res. 2023 Jan 1;25(1):102-110. doi: 10.1093/ntr/ntac159.
Helping smokers to quit is an important task of general practitioners (GPs). However, achieving tobacco abstinence is difficult, and smokers who fail may still want to improve their health in other ways. Therefore, Swiss GPs developed a multithematic coaching concept that encourages health behavior changes beyond smoking cessation alone.
To compare the effectiveness of such coaching with state-of-the-art smoking cessation counseling, we conducted a pragmatic cluster-randomized two-arm trial with 56 GPs in German-speaking Switzerland and 149 of their cigarette smoking patients. GPs were instructed in either multithematic health coaching or smoking cessation counseling. After 12 months, we compared their patients' improvements in cigarette consumption, body weight, physical inactivity, alcohol consumption, stress, unhealthy diet, and a health behavior of their own choice, using hierarchical logistic regression models and Fisher's exact and t tests.
Over 95% of all participants achieved clinically relevant improvements in at least one health behavior, with no difference between study arms (health coaching vs. smoking cessation counseling: aOR = 1.21, 95% CI = [0.03-50.76]; and aOR = 1.78, 95% CI = [0.51-6.25] after non-responder imputation). Rates of clinically relevant improvements in the individual health behaviors did not differ between study arms either (they were most frequent in physical activity, achieved by 3 out of 4 patients), nor did the extent of the improvements.
Multithematic health coaching and state-of-the art smoking cessation counseling were found to be comparable interventions, both in terms of smoking cessation success and, quite unexpectedly, their effects on other health behaviors.
The findings of our study suggest that in general practice, multithematic health coaching is an effective smoking cessation intervention, and conversely, monothematic smoking cessation counseling also achieves the beneficial effects of a multithematic health behavior intervention. This opens up the possibility for GPs to support their smoking patients in improving their health behavior in additional and more flexible ways.
帮助吸烟者戒烟是全科医生（GP）的一项重要任务。然而，实现烟草戒除是困难的，未能成功戒烟的吸烟者可能仍希望以其他方式改善健康。因此，瑞士的全科医生开发了一种多主题的辅导概念，鼓励除了戒烟之外的健康行为改变。
为了比较这种辅导与最先进的戒烟咨询的效果，我们在瑞士德语区的 56 名全科医生和他们的 149 名吸烟患者中进行了一项实用的两臂随机分组试验。全科医生接受了多主题健康辅导或戒烟咨询方面的指导。12 个月后，我们使用分层逻辑回归模型和 Fisher 精确检验和 t 检验比较了他们的患者在吸烟量、体重、身体活动不足、饮酒、压力、不健康饮食以及他们自己选择的健康行为方面的改善情况。
超过 95%的参与者在至少一种健康行为方面取得了有临床意义的改善，研究组之间没有差异（健康辅导与戒烟咨询：aOR = 1.21，95%CI = [0.03-50.76]；非应答者推断后 aOR = 1.78，95%CI = [0.51-6.25]）。研究组之间在个别健康行为方面有临床意义的改善率也没有差异（最常见的是身体活动，4 名患者中有 3 名达到），改善的程度也没有差异。
多主题健康辅导和最先进的戒烟咨询被发现是可比的干预措施，无论是在戒烟成功方面，还是在其他健康行为方面，都有相当的效果。
我们的研究结果表明，在全科实践中，多主题健康辅导是一种有效的戒烟干预措施，反之，单一主题的戒烟咨询也能达到多主题健康行为干预的有益效果。这为全科医生提供了支持他们的吸烟患者以额外的、更灵活的方式改善健康行为的可能性。
