Smoking: Improved Quit Rates with Flo – 6 Month Evaluation of Smoking Cessation Pathway

As reported by the Public Health Agency in Northern Ireland (NI) “Smoking has been identified as the single greatest cause of preventable illness and premature death in Northern Ireland.” 

Data from 2014 showed that approximately 16% or 1 in 6 of all deaths in NI were attributable to smoking, including cancers, lung disease and circulatory diseases. 

Furthermore, in NI it has been estimated the costs of treating smoking-related illness in NI hospitals alone is around £164m a year.  Since 2015, decreasing rates of smoking has remained a priority for improving public health across NI.

Developing the pathway

With this ambition in mind, Northern Health & Social Care Trust (NHSCT) embarked on their journey with Flo, one of their first pathways being developed to help improve quit rates amongst clients who were trying to stop smoking. 

The smoking cessation team worked to develop a protocol in Flo that would support and encourage clients on their journey to becoming smoke-free, whilst monitoring throughout for observable behavior change.

Their pathway included a balance of advice and motivational messages targeted at supporting sustainable behavior change, such as:

“What have you found good so far about not smoking? Make a list and use this as a regular reminder to keep going. Flo”.

Clients were also asked regularly to rate how hard they were finding it to stay smoke-free and if they had smoked at all during the past week.

The program of support messages and interactive questions lasts for a total of 12 weeks, with additional evaluation questions to learn more about clients experiences a year after first engaging with the service to ask if they had remained smoke-free.

The first client was enrolled onto the NHSCT Stop Smoking Service on 18th November, and 6 months later an evaluation of the service to date was completed to help the team further develop the support Flo offered clients.  NHSCT have kindly agreed to share their evaluation. 

Findings at 6 months

Within the initial 6 month period, 50 clients were enrolled and 29 opted in to receive messages from Flo – as a first pathway, the team were hoping for an opt-in rate of 50%, but this was exceeded with 58% of clients opting in. 

It was hoped that at the 4-week mark 60% of clients on Flo would report staying smoke-free, however, the actual percentage was 69%, beating the target set out by the team.  In comparison, for clients who did not receive support from Flo, 53% reported that they were not smoking at the 4-week point.

Although not all clients completed the evaluation questions, those that did all agreed that Flo was useful in helping them to quit smoking.  Some clients also provided verbal feedback about Flo’s support:

“ It was helpful ”

“ It was useful to keep me motivated ”

“ It was good to keep me on track ”

NHSCT staff also agreed that Flo provided helpful additional support to their clients, and were pleased to see an improvement in quit rates without the use of excessive clinical time.  The 6-month evaluation concludes:

“ Florence has been a helpful additional aide to help smokers quit.  The quit rate of those using Flo is 16% more than those not using Florence.  It is popular with clients who find the messages useful in their quit attempt.  It has improved quit rates without using up excessive clinical time.  Increased quit rates will reduce medical costs in the short and long term.  ”

Next Steps

Based on verbal feedback from both staff and clients as well as client evaluation from Flo, the team plan to refine their pathway to further improve the experience. 

This will include reducing the number of times patients are asked if they are finding quitting difficult/if they are still smoking, including:

• more practical advice about cravings
• changing the wording of the evaluation questions
• discussing with clients at the time of enrollment the importance of answering the evaluation questions at the end of the protocol