Küçükaksu Müge H, Jansen Lola, Hoekstra Trynke, Helmig Sanne, Adriaanse Marcel C, van Meijel Berno
Department of Health Sciences and Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, Netherlands.
Department of Psychiatry, Amsterdam UMC and Amsterdam Public Health research institute, Amsterdam, Netherlands.
PLoS One. 2025 Apr 29;20(4):e0322160. doi: 10.1371/journal.pone.0322160. eCollection 2025.
Recently, a cluster-randomised controlled trial was conducted within Dutch ambulatory mental healthcare to assess the effectiveness of a one-year smoking cessation intervention consisting of group sessions, peer support and pharmacological treatment (KISMET). This article presents its process evaluation, exploring the perceptions of patients and mental healthcare professionals (MHPs) regarding the implementation of KISMET.
We conducted a mixed methods study, including 26 semi-structured interviews (10 MHPs and 16 patients) following the RE-AIM framework. Qualitative data was thematically analysed with MAXQDA software. We collected additional data on inclusion, drop-out and assessed treatment adherence during on-site observations.
Recruitment and subsequent retention of patients in the RCT was found to be challenging (58% drop-out at one-year follow-up). MHPs suggested more motivational enhancement techniques to aid recruitment and reduce study attrition. The intervention components were generally assessed positively. Patients experienced the group and peer support sessions as supportive and beneficial. Inconsistent group attendance was demotivating and disrupted implementation. Pharmacological treatment was found to be helpful, although MHPs mentioned the treating psychiatrist or clinical nurse specialist need to facilitate better to ensure medication supply. The handbook offered MHPs excellent guidance and significantly contributed to treatment fidelity. Surprisingly, the carbon monoxide monitoring (originally included in the study protocol for research purposes) was appraised as a motivational tool. Finally, shortage of staff, limited collaboration and high turnover were barriers for the delivery of the intervention. Implementation heavily depends on the quality of the collaboration between MHPs and patients, as well as the infrastructure created by the organisation.
This study demonstrates the benefits, unique demands and challenges of a smoking cessation intervention for people with SMI. Results could guide and improve the implementation of smoking cessation interventions in mental healthcare settings. Fostering a culture of connectivity through team development, along with the provision of supportive and communicative supervision is critical for the effective recruitment and retention in smoking cessation studies in psychiatric care.
最近，在荷兰门诊精神卫生保健机构开展了一项整群随机对照试验，以评估一项为期一年的戒烟干预措施的有效性，该干预措施包括小组会议、同伴支持和药物治疗（KISMET）。本文介绍了其过程评估，探讨了患者和精神卫生保健专业人员（MHP）对KISMET实施情况的看法。
我们进行了一项混合方法研究，按照RE-AIM框架进行了26次半结构化访谈（10名MHP和16名患者）。使用MAXQDA软件对定性数据进行了主题分析。我们在现场观察期间收集了关于纳入、退出的数据，并评估了治疗依从性。
发现随机对照试验中患者的招募和后续留存具有挑战性（一年随访时退出率为58%）。MHP建议采用更多动机增强技术来帮助招募并减少研究损耗。干预措施的各个组成部分总体上得到了积极评价。患者认为小组和同伴支持会议具有支持性且有益。小组出席情况不一致会降低积极性并干扰实施。虽然MHP提到治疗精神科医生或临床护士专家需要更好地提供便利以确保药物供应，但发现药物治疗是有帮助的。该手册为MHP提供了出色的指导，并对治疗保真度有显著贡献。令人惊讶的是，一氧化碳监测（最初为研究目的纳入研究方案）被评价为一种激励工具。最后，人员短缺、协作有限和人员流动率高是实施干预措施的障碍。实施很大程度上取决于MHP与患者之间合作的质量，以及组织创建的基础设施。
本研究证明了为严重精神疾病患者开展戒烟干预措施的益处、独特需求和挑战。研究结果可为精神卫生保健环境中戒烟干预措施的实施提供指导并加以改进。通过团队发展培养一种联系文化，同时提供支持性和沟通性监督，对于精神科护理中戒烟研究的有效招募和留存至关重要。
