The context of the Emergency department as a location for a smoking cessation intervention – process evaluation findings from the COSTED trial

Introduction: Hospital emergency departments (ED) offer an opportunity to engage with large numbers of people who smoke to prompt cessation, although acceptability of opportunistic intervention in this context has been questioned. This process evaluation study was embedded into the COSTED randomised controlled trial (RCT) and sought to explore the context of intervention delivery within the ED.
Methods: Qualitative interviews were conducted with participants and staff across six EDs participating in the COSTED RCT. Interview data were thematically analysed 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 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 legitimise 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 responding 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 legitimised 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 of delivering the COSTED intervention in the ED.