Behavior change technique delivery during routine smoking cessation advice in primary care and associations with abstinence

Background: Little is known about the content of routine smoking cessation support in primary care and how it relates to abstinence. While 121 behavior change techniques (BCTs) have been identified for cessation treatment, English treatment guidelines recommend 30 across cessation consultations. Purpose: We sought to identify: (1) BCTs delivered during routine cessation support in primary care in England; (2) associations between abstinence and (a) the total number of BCTs used, (b) delivery of the 30 recommended BCTs, (c) delivery of individual BCTs. 

Method(s): In an evaluation trial across 32 English General Practices, 149 pre-quit consultations (across 29 practitioners trained in cessation support) from a multisession cessation program were audio-recorded, transcribed, and analyzed for BCT delivery using a modified BCT taxonomy v1 and smoking-specific taxonomy. Abstinence was collected at 4-weeks (biochemically verified), 8-weeks (primary outcome, self-reported), and 6-months (self-reported) post quit date. Multilevel modelling assessed associations. 

Results: Of 121 BCTs, 85 were delivered in at least one consultation. A mean of 13.4 (SD = 2.76) of recommended BCTs were delivered, with 33% (10/30) delivered in at least half of the consultations. Total BCTs delivered were not associated with abstinence. Delivery of more guideline-recommended BCTs was only associated with abstinence at 4 weeks (OR = 1.03, 95% CI 1.00–1.06; P = .03). One BCT was positively associated, and one negatively associated with abstinence. 

Conclusions: One-third of recommended BCTs were delivered in at least 50% of initial consultations, with delivery associated with short-term abstinence. Limited practitioner time may constrain BCT delivery and is a consideration for future guidelines. Clinical Trials information: The Clinical Trials Registration #ISRCTN 56702353.