Development of Typology-based Smoking Relapse Prevention: A Q-methodology and a Pilot Randomized Controlled Trial

Smoking Cessation Clinical Trial

Official title:

Development of Typology-based Smoking Relapse Prevention: A Q-methodology and a Pilot Randomized Controlled Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06261385
• Other study ID #: typology
• Status: Recruiting
• Phase: N/A
• Start date: January 23, 2024
• Est. completion date: January 31, 2025

Study information

• Verified date: January 2024
• Source: The University of Hong Kong
• Contact: Derek Yee Tak CHEUNG, Dr.
• Phone: 39176652
• Email: derekcheung[@]hku.hk
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study aims to develop a typology-based intervention delivered by smoking cessation (SC) counselors to prevent smoking relapse in ex-smokers who recently quit. The two main research questions include (1) Can a typology-based smoking relapse prevention intervention be feasible and accepted by the smokers and SC counselors who deliver the new intervention? (2) What is the preliminary evidence on the efficacy of the typology-based smoking relapse prevention to increase tobacco abstinence in ex-smokers who have recently quit? If the intervention shows at least a small effect size (i.e. risk ratio>1.3), or the intervention is feasible while modifications can potentially increase the efficacy, a future definitive RCT is warranted.

Description:

This pilot study includes three phases. The first phase will be a Q-sorting process on the Q-statements which have been developed in the pilot study. Phase 2 will be the development of a typology assessment tool, intervention protocol, and training. Phase 3 will be a pilot randomized controlled trial to examine the feasibility, acceptability and preliminary efficacy of the typology-based intervention. Ethics approval will be obtained from the Institutional Review Board of the University of Hong Kong/Hong Kong Authority Hong Kong West Cluster.

This study protocol complies with the Declaration of Helsinki and the International Conference on Harmonisation Guideline for Good Clinical Practice (ICH-GCP).

Phase 1 Q-method study (5 months) In phase 1, ex-smokers will be recruited online and in local community-based SC clinics. Mass mails including study details will be sent to all HKU staff and students. Recruitment ads will also be posted on online platforms such as Google, Facebook, and Instagram. Participants will be directed to an online Qualtrics to complete a brief screening questionnaire and provide their contact information for the sign-up process. SC clinics or services under Tung Wah Group of Hospitals, Pok Oi Hospital, Hospital Authority (HA), and Youth Quitline of the University of Hong Kong, which offer behaviour and/or pharmacological interventions. The investigators have successful experience collaborating with these service providers in recruiting smokers for several projects. For example, the investigators recruited 1,008 ex-smokers from these service providers in an HMRF-funded project in 2018-2019 (Project No. 15163001). In these clinics, potential participants shall be identified by the SC counsellors and referred to our research assistants to proceed with enrolment. In phase 3, the investigators will only recruit ex-smokers from SC clinics, because biochemical verification of both abstinence and habitual tobacco use before quitting in ex-smokers recruited from the community does not exist.

The Q-statements have been developed in our aforementioned pilot study. The Q-sorting process will be conducted on an online platform "easyHTMLQ" (Appendix 2), which is designed for completion of the Q-sorting. In this self-explanatory website, participants can easily drag the statements into the Q-sort grid according to their agreement level, and provide detailed reasons for their choices. Also, the research assistant will communicate with participants online and monitor the Q-sorting process. After the Q-sort process, the results will be documented and exported for further data analysis.

Phase 2 Intervention development (6 months) In phase 2, the investigators shall invite SC counsellors from the above SC clinics to participate in either face-to-face or online project meetings to provide feedback on the intervention protocols.

This phase aims to develop a typology assessment tool and design a typology-based intervention protocol, using the findings in Phase 1, the 3 aforementioned principles of typology-based intervention, and current smoking cessation guidelines. The screening protocol will include distinguishing statements found in Phase 1 that can characterise ex-smokers. The intervention protocol will include specific counselling principles and content for each ex-smoker class and a series of typology-based e-messages to be delivered to the corresponding class of ex-smokers via WhatsApp after counselling. The counselling shall take 5 to 10 minutes and can be fitted in current intervention protocols (5A/5R/Motivational Interview), that can address quit motivation, smoking cues and nicotine dependence.

After intervention development, the project team will invite SC counsellors for a project meeting to provide feedback on the intervention protocols. Afterwards, the project team shall revise the protocols and deliver a briefing for the SC counsellors who will deliver the intervention in Phase 3.

Phase 3 Pilot randomized control trial (7 months) The pilot 2-arm, parallel, open-labelled RCT (allocation ratio 1:1) aims to examine the feasibility, acceptability and preliminary efficacy of the typology-based intervention. SC counsellors who attend the briefing in Phase 2 will screen and recruit their SC clients to receive the typology-based intervention for smoking cessation. The SC counsellors from local clinical settings that can recruit a relatively large number of participants within the 12-week recruitment will be included, to ensure timely recruitment of sufficient participants.

During the last remote consultation with a client (mostly at 8 weeks), the SC counsellors will assess their eligibility. If they are eligible, the SC counsellors will seek their written consent and randomize them to either the intervention group or the control group. In the intervention group, in addition to routine counselling (15-30 minutes), they will classify their identity with our screening tool (developed in Phase 2) and then apply the counselling protocol for the participants (5-10 minutes). After the counselling session, the personalized e-messages will be sent to the participants by our research staff for 4 weeks.

In the control group, routine smoking cessation counselling, including generic advice on preventing smoking relapse, will be retained, and no e-messages will be sent. The investigators only deploy usual practice but not equal contact/attention treatment for the control group because the investigators aim for a superiority trial to assess the preliminary efficacy of the new intervention.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 510
• Est. completion date: January 31, 2025
• Est. primary completion date: October 31, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria (for Ex-smoker) :

• Have ever habitually used conventional cigarettes in the past year

• Not using cigarettes for past 7 days

• Aged 18 years or above

• No barriers in speaking and listening Chinese

Exclusion Criteria (for Ex-smoker) :

• Have unstable physical or psychological conditions as advised by doctors or counsellors

• Users of illicit drugs (e.g., heroin, marijuana, ketamine, etc.)

• Have become pregnant in the past two months

Inclusion Criteria (for SC counsellors) :

• SC counsellors from local SC clinics under Tung Wah Group of Hospitals, Pok Oi Hospital, Hospital Authority (HA), and Youth Quitline of the University of Hong Kong.

Related Conditions & MeSH terms

• Recurrence
• Smoking Cessation

Intervention

Behavioral:
• typology-based intervention
A typology-based intervention delivered by smoking cessation (SC) counsellors to prevent smoking relapse in ex-smokers who recently quit

Locations

Country	Name	City	State
Hong Kong	LKS Faculty of Medicine	Hong Kong

Sponsors (2)

Lead Sponsor	Collaborator
The University of Hong Kong	Health and Medical Research Fund

Country where clinical trial is conducted

Hong Kong, 

References & Publications (25)

Berger J, Rand L. Shifting Signals to Help Health: Using Identity Signaling to Reduce Risky Health Behaviors. Journal of Consumer Research. 2008;35(3):509-18.

Census & Statistics Department (Hong Kong SAR government). Thematic Household Survey, Report No. 64: Pattern of Smoking. Hong Kong: Census & Statistics Department 2018.

Census & Statistics Department (Hong Kong SAR government). Thematic Household Survey, Report No. 70: Pattern of Smoking. Hong Kong: Census & Statistics Department 2020.

Cheung YT, Chan CH, Lai CK, Chan WF, Wang MP, Li HC, Chan SS, Lam TH. Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial. J Med Internet Res. 2015 Oct 22;17(10):e238. doi: 10.2196/jmir.4829. — View Citation

Food and Health Bureau, Department of Health. Towards 2025: Strategy and action plan to prevent and control non-communicable diseases in Hong Kong. Hong Kong: Department of Health; 2018.

GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease — View Citation

Hartmann-Boyce J, Livingstone-Banks J, Ordonez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2021 Jan 4;1:CD013229. doi: 10.1002/14651858.CD013229.pub2. — View Citation

Jackson SE, McGowan JA, Ubhi HK, Proudfoot H, Shahab L, Brown J, West R. Modelling continuous abstinence rates over time from clinical trials of pharmacological interventions for smoking cessation. Addiction. 2019 May;114(5):787-797. doi: 10.1111/add.14549. Epub 2019 Jan 29. — View Citation

Kufeld C. A Q-Methodology study investigating the identity self-descriptions of a group of ex-smokers. England: University of Luton; 2004.

Lam TH. Absolute risk of tobacco deaths: one in two smokers will be killed by smoking: comment on "Smoking and all-cause mortality in older people". Arch Intern Med. 2012 Jun 11;172(11):845-6. doi: 10.1001/archinternmed.2012.1927. No abstract available. — View Citation

Livingstone-Banks J, Norris E, Hartmann-Boyce J, West R, Jarvis M, Hajek P. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev. 2019 Feb 13;2(2):CD003999. doi: 10.1002/14651858.CD003999.pub5. — View Citation

Luk TT, Cheung YTD, Chan HC, Fok PW, Ho KS, Sze CD, Lam TH, Wang MP. Mobile Chat Messaging for Preventing Smoking Relapse Amid the COVID-19 Pandemic: A Pilot Randomized Controlled Trial. Nicotine Tob Res. 2023 Jan 5;25(2):291-297. doi: 10.1093/ntr/ntac045. — View Citation

McGhee SM, Ho LM, Lapsley HM, Chau J, Cheung WL, Ho SY, Pow M, Lam TH, Hedley AJ. Cost of tobacco-related diseases, including passive smoking, in Hong Kong. Tob Control. 2006 Apr;15(2):125-30. doi: 10.1136/tc.2005.013292. — View Citation

Meijer E, Gebhardt WA, Dijkstra A, Willemsen MC, Van Laar C. Quitting smoking: The importance of non-smoker identity in predicting smoking behaviour and responses to a smoking ban. Psychol Health. 2015;30(12):1387-409. doi: 10.1080/08870446.2015.1049603. Epub 2015 Jun 3. — View Citation

Montes KS, Pearson MR. I am what I am: A meta-analysis of the association between substance user identities and substance use-related outcomes. Psychol Addict Behav. 2021 May;35(3):231-246. doi: 10.1037/adb0000721. Epub 2021 Apr 8. — View Citation

Oyserman D, Smith GC, Elmore K. Identity-based motivation: Implications for health and health disparities. J Soc Iss. 2014;70(2):206-25.

Oyserman D. Identity-based motivation: Implications for action-readiness, procedural-readiness, and consumer behavior. J Consum Psychol. 2009;19(3):250-60.

Smith AL, Chapman S, Dunlop SM. What do we know about unassisted smoking cessation in Australia? A systematic review, 2005-2012. Tob Control. 2015 Jan;24(1):18-27. doi: 10.1136/tobaccocontrol-2013-051019. Epub 2013 Sep 11. — View Citation

Susan ER, Isadore N. Q Methodology and Its Position in the Mixed-Methods Continuum. Operant Subjectivity. 2011;34(3):172-91.

Tajfel H, Turner JC. The Social Identity Theory of Intergroup Behavior. In: Sidanius JTJJ, editor. Political psychology: Key readings. Key readings in social psychology. New York, NY, US: Psychology Press; 2004. p. 276-93.

Tombor I, Shahab L, Herbec A, Neale J, Michie S, West R. Smoker identity and its potential role in young adults' smoking behavior: A meta-ethnography. Health Psychol. 2015 Oct;34(10):992-1003. doi: 10.1037/hea0000191. Epub 2015 Jan 26. — View Citation

Watts S, Stenner P. Doing the fieldwork: participants, materials and procedure. 2012 2022/03/11. In: Doing Q Methodological Research: Theory, Method and Interpretation [Internet]. London: SAGE Publications Ltd; [69-90]. Available from: https://methods.sagepub.com/book/doing-q-methodological-research.

Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Apr 10;4(4):CD006611. doi: 10.1002/14651858.CD006611.pub4. — View Citation

World Health Organization. A guide for tobacco users to quit. Geneva: World Health Organization; 2014.

Zabala A, Pascual U. Bootstrapping Q Methodology to Improve the Understanding of Human Perspectives. PLoS One. 2016 Feb 4;11(2):e0148087. doi: 10.1371/journal.pone.0148087. eCollection 2016. — View Citation

* Note: There are 25 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	self-reported abstinence in the past 30 days at 2-month follow-up		2 months
Primary	iScreen OFD Cotinine Saliva Test Kit (<30ng/ml) biochemical validated tobacco abstinence	Participants who report tobacco abstinence will be invited for a biochemical validation to test if his/her saliva cotinine is less than 30ng/ml measured by the iScreen OFD Cotinine Saliva Test Kit.	2 months
Primary	the difference of the feasibility and acceptability score of the typology-based intervention between the intervention and control group.	We will have 4 feasibility questions for participants to answer from 1 (Completely disagree) to 5 (Completely agree). Also, we will have 13 acceptability questions modified from Treatment Acceptability/Adherence Scale (TAAS), graded from 1 (Disagree strongly) to 7 (Agree strongly). We would like to observe if there is difference between the score from intervention group and control group	2 months
Secondary	Time required for the counselling		2 months
Secondary	Compliance rate of the SC counsellors in following the intervention protocol		2 months
Secondary	Proportion of screened clients who participate in the RCT		2 months
Secondary	Dropout rate of the participants who consent to the RCT		2 months
Secondary	Satisfaction on the SC counsellors	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Satisfaction on the e-messages	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Frequency of reading the e-messages		2 months
Secondary	Perceived effectiveness on the intervention	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Satisfaction on the enrolment procedures	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Intention to recommend the intervention to other smokers	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Satisfaction about the intervention from SC counsellor	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Perceived appropriateness of the intervention length from SC counsellor	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Satisfaction on the enrolment procedures from SC counsellor	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Perceived effectiveness of the screening tool from SC counsellor	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Perceived clients' acceptance of the intervention from SC counsellor	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months
Secondary	Intention to apply this intervention in other clients from SC counsellor	We will have 8 questions, graded from 1 (very disagree) to 5 (very agree)	2 months