Effectiveness and feasibility of a web-based multiple tailored smoking cessation programme and tailored counseling by practice nurses

The smoking of tobacco continues to be a major preventable cause of illness
(including several types of cancer) and premature death. Quitting smoking
therefore improves smokers* life expectancy and quality of life. People
surrounding the smoker benefit as well, as passive smoking rates decrease. In
order to stimulate and aid smokers to quit, many different smoking cessation
interventions have been developed. Stand-alone interventions have often limited
success, suggesting multi-faceted approaches. Multiple tailored programmes and
advice by general practitioners (GPs) concerning smoking cessation have proved
to be effective stand-alone interventions. However, multiple tailoring
concerning smoking cessation is not offered to the general public and GPs
indicate they are not using their full potential when it comes to smoking
cessation advice to their patients. Practice nurses are a promising
alternative, but so far it is not clear whether their advice is as effective as
that of a GP or whether this approach will be adopted by general practice.

The main goal of this study is to test whether offering a web-based multiple
computer-tailored programme and the additional effect of a tailored counseling
protocol for practice nurses to adult smokers wanting to quit within six months
(preparer or contemplator), results in a significant higher percentage of quit
attempts, higher rates of point prevalence abstinence and of sustained
abstinence compared to usual care in general practice.

Randomized controlled trial (RCT).

Respondents in the multiple tailoring group (first experimental condition) will
receive multiple computer tailoring feedback on four moments: baseline, six
weeks, six months and two days after the quit date they set at baseline. At 12
months follow-up they will be asked to fill out one last questionnaire.
Respondents in the multiple tailoring and counseling by practice nurses group
(second experimental condition) will receive multiple tailoring as in the first
experimental condition, with an additional counseling meeting with a practice
nurse. After receiving the first tailored feedback, respondents will be
prompted to make an appointment with the practice nurse in their general
practice for a counseling session. At 12 months follow-up they will be asked to
fill out one last questionnaire.
Respondents in the group that will receive usual care (control group) will not
receive any intervention and only fill in the questionnaires at baseline, at
six week follow-up and at six and 12 months follow-up.

Participants in both experimental conditions will be offered four tailored
feedback messages. To obtain this feedback, participants have to fill out a
questionnaire at multiple points in time (at baseline, six weeks, six months
and two days after the set quit date).
For the multiple tailoring only group, all four advices are internet-based and
will be displayed on the participant*s screen immediately after filling out the
questionnaire. For the second experimental group, the second tailored advice is
replaced by a tailored counseling session by a practice nurse. At 12 months
after baseline, respondents are again asked to fill out an online
questionnaire.
Participants in the control group will fill out questionnaires at baseline, six
week, six and 12 months follow-up, without receiving any type of feedback.
Respondents* self-report to have refrained from smoking will be biochemically
validated by means of a saliva swap/cotinine test at 12 months follow-up.
Participation in this study is voluntarily and without any risk.