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ToolsNotley, Caitlin, Belderson, Pippa, Ward, Emma, Clark, Lucy V., Clark, Allan, Stirling, Susan, Parrott, Steve, Li, Jinshuo, Coats, Timothy J., Bauld, Linda, Holland, Richard, Gentry, Sarah, Agrawal, Sanjay, Bloom, Benjamin M., Boyle, Adrian, Gray, Alasdair, Morris, M. Geraint and Pope, Ian (2025) The context of the emergency department as a location for a smoking cessation intervention – process evaluation findings from the COSTED trial. Nicotine and Tobacco Research, 27 (5). 909–916. ISSN 1462-2203
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Abstract
Introduction: Hospital emergency departments (ED) offer an opportunity to engage with large numbers of people who smoke to prompt cessation, although the acceptability of opportunistic intervention in this context has been questioned. This process evaluation study was embedded into the Cessation of Smoking Trial in the Emergency Department (COSTED) randomized controlled trial and sought to explore the context of intervention delivery within the ED. Aims and Methods: Qualitative interviews were conducted with participants and staff across six EDs participating in the COSTED randomized controlled trial. Interview data were thematically analyzed specifically exploring contextual influences. Data were triangulated with ethnographic observations. Results: In participant interviews (N = 34), it was acceptable overall to receive a brief opportunistic smoking cessation intervention in the ED. Contextual factors are impacted at a range of levels. At the micro level participant views and experiences combined with staff tailoring were important. Being given an e-cigarette starter kit by a “credible source” helped to legitimize vaping for smoking cessation and gave confidence in personal ability to switch away from tobacco. At the meso level, adaptations to intervention delivery were made in response to the context of the ED. Stop smoking advisors (N = 11) had to adapt and deliver the intervention flexibly depending on space and clinical need. At the macro level, hospital policies supportive of vaping legitimized the approach. Conclusions: Smoking cessation outcomes reported in the main trial across sites were very similar because of the high credibility, acceptability, and flexible approach to delivering the COSTED intervention in the ED.
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