Barriers and facilitators to delivering a usual care smoking intervention as part of a cRCT based in services for people experiencing homelessness: researcher observations

Citation

McMillan L & Ford A (2023) Barriers and facilitators to delivering a usual care smoking intervention as part of a cRCT based in services for people experiencing homelessness: researcher observations. SRNT-E, London, England, 13.09.2023.

Abstract
Around 76% of people experiencing homelessness in the UK smoke, yet staff at homelessness services are rarely trained in smoking cessation practices. As part of a nationwide cluster randomised controlled trial (cRCT), staff in 32 services across Scotland, England, and Wales were trained to deliver smoking cessation support to measure the effectiveness of e-cigarette starter kit (EC) provision versus a usual care (UC) intervention for smokers accessing homelessness services. For 16 of these services, the intervention (UC) consisted of staff delivering very brief advice (VBA+) and signposting participants to their local Stop Smoking Service (SSS). Staff (n=105) at UC sites received smoking cessation training prior to recruitment, which covered VBA+ and how to signpost to the SSS. Little is documented on the delivery of such smoking interventions in this sector, thus we will outline some of the key barriers and facilitators encountered in terms of training, recruitment, and intervention delivery across UC sites, that we observed. Staff training was key to facilitating recruitment and delivery of the UC smoking intervention to 238 participants as knowledge of stop smoking practices was low across services. Staff recruitment of participants was more challenging in UC sites compared to EC sites due to lower staff engagement and uninformed recruitment strategies from those who were unable to attend the initial training (contrary to VBA+). Intervention delivery was hindered by reduced staff capacity at some UC sites as staff were unable to facilitate referrals due to preexisting workloads, compounded by the complex needs of this population and a distrust of health services that was prevalent in our sample. Whilst training was well received and pivotal, further ongoing refresher training would be beneficial to support staff to reiterate the key messages of VBA+ during recruitment and intervention delivery, and to embed VBA+ into everyday practice. From our experience, additional resources beyond those we provided are also required to overcome barriers associated with staff capacity and to adequately support the complex needs of this population. Our forthcoming trial results and an embedded process evaluation will provide further insight into the challenges of delivering smoking interventions in this sector.