Telephone counseling versus text messaging for supporting post-discharge quit attempts

among hospitalized smokers in Brazil: a feasibility study

Érica Cruvinel, Dra.Kimber Richter, Dr. Fernando Colugnati, Rafaella Russi, Juliana Oliveira, Taynara Formagini, Denislaine Honorato, Ana Lúcia Vargas, Ligia Amaral, Dr.Telmo Mota Ronzani.

Psychology Departament, UFJF, Minas Gerais, Brazil

AMERSA 38th Annual National ConferenceNovember 6-8, 2014

Background

Hospitalization is a good time to quit smoking:

▪ Many hospitals restrict or prohibit smoking;

▪ Patients in contact with health professionals

▪ Teachable moment: may boost receptivity to smoking

cessation by increasing perceived vulnerability

Hospitalized smokers must receive inpatient treatment and post-discharge follow up for at least 1 month to successfully be quit at 12 months post-discharge (RR=1.37; 95% CI 1.27-1.48; Rigotti, 2012)

Background

The Cochrane database of systematic reviews – Tobacco addiction group (Rigotti, 2012)

(50 studies were included)

42 gave post-discharge support

29 were by phone support

2 internet, e-mail, IVR system

Motivational Interview(MI)

Text message

Background

Brazilian National Program - free treatment (counseling and RNT) - Primary Care Clinics (INCA, 2001).

Little research exists regarding the best way to support patients post-discharge in the Brazilian health care system.

Objective

To conduct a pilot study comparing the effectiveness of two ways of providing outpatient support versus a control condition.

Methods

Study context

CREPEIA (Centro de Referência em Pesquisa, Intervenção e Avaliação em Álcool e Outras Drogas)

CIPIT (Centro Interdisciplinar de pesquisa e Intervenção em Tabagismo)

UKanQuit (KU Medical Center), Kansas, U.S.

CIPIT

Methods

Design All patients admitted to the University Hospital

of Juiz de Fora (HU/UFJF) in Minas Gerais were screened for past 30-day tobacco use

Inclusion Criteria Past 30-day tobacco use Over 18 Yrs old Cell phone Physically and Cognitively able

Methods

Exclusion Criteria Significant co-morbidity or issue that would

prevent participation (e.g., acute life-threatening medical illness, communication barriers, altered mental status, etc.)

Intensive care

Randomization Modified cluster randomization Random list from R program

Methods

Control Group Standard bedside treatment (Brief intervention + NRT) (All Groups Received)

Motivational Interviewing Group Weekly frequency – By phone Theoretical approach - Miller & Rollnick, 2001 Guided by readiness to quit stages

Text Message Group One message weekly Personalized message 160 characters

Assessed for

Eligibility(55)

Enrolled & Randomized (n=33)

Excluded (n=22):5 Not eligible1Declined to participate16 Other

TEXT MESSAGE(n=12 allocated)

Sessions Done Participants % (No.)______________________________THE ALL OF 12 PATIENTS RECEIVED 4 TEXT MESSAGES

1 Month Assessment

36.4% Completed (n=4 )

7 - Unreachable*

1 Month Assessment

66.7 % Completed (n=8)

4 - Unreachable

1 Month Assessment

80.0% Completed (n=8)

2 - Unreachable3 Month Assessment

36.4% Completed (n=4)

7 - Unreachable*

3 Month Assessment

50.0% Completed (n=6)

6 - Unreachable **

3 Month Assessment

50% Completed (n=5)

5 - Unreachable***

MI (n=11 allocated)

Sessions Done Participants % (No.)______________________________≥ 1 63.6 (7)1

≥ 2 45.5 (5)≥ 3 45.5 (5)4 27.3 (3)

CONTROL(n=10 allocated)

Sessions Done Participants % (No.)_________________________________ ___ ______ ___ ______ ___ ______ ___ ___

Included in ITT analysis (n=11) Included in ITT analysis (n=12) Included in ITT analysis (n=10)

Results

Tobacco prevalence among all patients screened: 16.4%

Table 1: Baseline Caracteristics (n = 33)

Sociodemographics M I (N=11) Text (N=12)

Control (N=10)

Age, mean (SD), yrs 55.44 (12.27)

47.5 (9.95)

44.1 (14.8)

Female, n (%) 7 (63.6%) 4 (33.3%) 3 (30%)

High school education or Less, n (%)

9 (81.8%) 8(66.7%) 5 (50%)

Mental Health Co-Morbidities

PHQ-2, Depression ≥ 3 n (%) 7 (63.6%) 7 (58.3%) 5 (50%)

AUDIT C, high risk drinking ≥ 4, n (%)

7 (63.6%) 6 (50%) 7 (70%)

Current Smoking

Average no. days smoked in the past 30 days, mean (SD)

23.27 (9) 23.82 (6,3)

24 (12.13)

Current cigarettes per day, mean (SD)

17.7 (10.7) 11.92 (5.8)

17.1 (16.7)

Smoking History

Other householder smoke n (%) 3 (27.3%) 7 (58.3%) 7 (70%)

Planning to stay quit or try to quit after discharge n (%)

9 (81.8%) 10 (83.3%)

6 (60%)

Results - Quit rates Table 2: Quit Rates for Interventions and Control Groups

Motivational Interview (n = 11)

Text Message (n = 12)

Control (n =10)

Outcome at the 1-month follow-up

Prevalence cessation, n (%) 2 (18.2%) 1 (8.3%) 1 (10%)

Outcome at the 3-month follow-up

Prevalence cessation, n (%) 2 (18.2%) 1 (8.3%) 1 (10%)

Results: Implementation variables

Table 3: Implementation variables - Motivational Interview and Text Message pos-discharge follow up

Motivational Interview (n = 11)

Number of patients contacted at the first MI call, n (%)

7 (63.7%)

Patients contacted that received at least 3 MI calls 5 (71.4%)

Patients contacted that received 4 MI calls 3 (42.8%)

First Call duration - Min, mean (SD) 12 (8.56)

Perception about number of calls, (just right) n (%) 2 (67%)

Perception about duration of calls, (just right time) n (%)

(3) 100%

Text message (n = 12)

Own a cell phone, n (%) 8 (66.7%)

Perception about message content (useful or a really useful) n (%)

6 (75%)

Perception about number of text message (just right number), n (%)

4 (57.1%)

CATEGORIES

no. (%) Examples (All messages end with: For help call: (CIPIT Phone number)

Health 15 (41.6)

I am worried about smoking because I had heart surgery

Bad taste and smell

4 (11.1) I don't like how cigarettes make my hair and clothes stink

Cost 3 (8.3) My smoking routine bothers me because some days I have money and other days not

Personal or family well-being

3 (8.3) I think my smoking interferes with the wellbeing of my children and boyfriend

Other 11 [Weight loss, smoke irritation, self-esteem, shame]

Total 36

Text messages to self

Lessons from Pilot Text messaging and Motivational

Interviewing are feasible and are good potential resources for Brazilian health care system

Learned numerous strategies to make study more pragmatic, especially MI arm

Changes in inclusion criteria will decrease drop outs

Thank you!Thank you!

ecruvinel@yahoo.com.br

Acknowledgments: CNPQ, CAPES, FAPEMIG