- Title
- Adherence to smoking cessation medications: investigating relevant factors and developing strategies to improve smoking cessation and medication adherence
- Creator
- Mersha, Amanual Getnet
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- BACKGROUND: Tobacco smoking accounts for 11.5% of deaths globally. The Australian Burden of Disease study estimated that tobacco smoking accounts for one in every eight deaths. Tobacco control is an integral part of the sustainable development goal (SDG-3), a goal for strengthening the implementation of the WHO FCTC around the globe. Smoking cessation is one of the most important and cost-effective preventive health measures to reduce the risk of mortality and morbidity. Smoking cessation can be achieved through a variety of methods, but the most widely accepted approach involves seeking behavioural support from a health professional, with or without pharmacological therapy. Tobacco treatment guidelines and professional societies around the globe recommend the use of smoking cessation medications (SCMs) for tobacco treatment. SCMs reduce the extent of withdrawal symptoms and work by reducing the occurrence and strength of urges to smoke or cravings. There are three pharmacotherapies currently licensed widely throughout the globe for smoking cessation: Nicotine replacement therapy (NRT), bupropion, and varenicline. However, there are inconsistent findings across studies regarding the effectiveness of SCMs. The variations in the effectiveness could be partially explained by the inconsistent use of the SCMs. AIMS: This thesis aims to answer the following key research questions, in a systematic way, using three phases: Phase 1: What is the level of adherence to SCMs and its impact on smoking cessation? Aims: I. To synthesis studies describing adherence to SCMs and produce a pooled estimate of the level of adherence and its effect on the success of quit attempts. (Chapter 2) II. To explore the level and impact of adherence and other relevant factors on successful quitting among smokers and ex-smokers in Australia. (Chapters 4, 5) Phase 2: What are the barriers and facilitators of adherence to SCMs? Aims: I. To synthesis and summarise studies that explored factors associated with adherence to SCMs by using a predefined behavioural model (COM-B model). (Chapter 3) II. To explore the barriers and facilitators to adherence to SCMs among smokers and ex-smokers in Australia. (Chapter 4) III. To explore the attitude, practice, and perceived barriers to adherence support provision among health care providers (HCP) in Australia. (Chapter 6) Phase 3: How can we improve adherence to SCMs? Aims: I. To determine modes of intervention delivery strategies to improve the rate of successful smoking cessation. (Chapter 7) II. To co-design an intervention directed to improve adherence to SCMs and successful quitting in Australia. (Chapter 8). METHODS: This thesis used multiple methodologies to address the research objectives. Seven studies were conducted in three phases. I began this program of work by conducting a systematic review and meta-analysis to evaluate the rate and impact of adherence to NRT using studies conducted in various countries. This was followed by a systematic review to evaluate the barriers and facilitators of adherence to NRT using a theoretical framework, the Capability, Opportunity, Motivation, and Behaviour (COM-B) Model. Based on the findings from the reviews, cross-sectional studies were conducted in Australia to evaluate the contemporary level of adherence, the factors associated with adherent SCM use, and the effect of adherence on smoking cessation. To evaluate adherence, participants’ self-reported duration and weekly consumption pattern of SCMs were used. Participants were considered adherent if they utilised SCMs for a minimum of 4 weeks and, on average, for 5 or more days per week. A further descriptive study was conducted to evaluate the attitudes and practices of HCPs towards adherence to SCMs in Australia. Finally, a systematic stepped approach using the BCW guide and modified consensus-based Delphi study among expert panels was conducted to design interventions targeted to improve adherence to SCMs. To investigate the mode of intervention for the proposed interventions, an umbrella review was used in addition to the HCP survey and consultation with expert panels in the modified Delphi study. KEY FINDINGS: 1. The level of adherence to SCMs was found to be low and significantly associated with successful smoking cessation. I. Only one in four participants were found to be adherent to SCMs in a meta-analysis as well as a national cross-sectional study in Australia. II. Adherence to SCMs was found to be associated with a two-fold increase in successful smoking cessation. 2. A range of factors were associated with adherence to SCMs. I. A multitude of factors related to the person making a quit attempt such as forgetfulness and attitude towards the medications were found to be associated with adherence to SCMs. II. Various perceived barriers to providing adherence services by HCPs were reported such as lack of skill, lack of knowledge, and lack of resources. 3. Improving adherence to smoking cessation medications is a complex issue that requires a comprehensive approach using multiple intervention delivery modes. I. Superior effectiveness in smoking cessation was achieved when face-to-face approaches were blended with web and/or mobile-based modes of intervention. Participating HCPs in Australia considered face-to-face, mobile phone-based, and web-based interventions as acceptable and effective modes to deliver adherence support. II. Improving adherence to SCMs requires a multi-level and comprehensive adherence approach. An adherence support wheel was designed to guide implementation strategies and programmes to improve adherence and enhance the effectiveness of SCMs. The adherence wheel incorporated 13 strategies including providing detailed instruction on how to use SCMs; establishing a realistic expectation about SCMs; and providing training for HCPs regarding comprehensive smoking cessation care with specifics on the provision of adherence support. DISCUSSION AND CONCLUSION: This thesis provides robust evidence regarding relevant factors and strategies to improve adherence to SCM and smoking cessation. Improving adherence to SCMs is a complex issue that requires a comprehensive approach and interventions rather than focusing on a single intervention strategy. The designed adherence support wheel can potentially be used to inform future smoking cessation trials and programmes. Further research is required to test the effectiveness and to identify opportunities for further enhancing the suitability of the proposed adherence support strategies elicited using the adherence support wheel. The findings from this thesis can be used to inform current clinical practice and relevant policies targeted to curb the burden of smoking through improving the effectiveness of SCMs, adherence, and smoking cessation. This thesis can contribute a new strategy to improve the effectiveness of smoking cessation medications and provide a valuable input for Australia’s national goal to reduce the rate of smoking below 10% in 2025.
- Subject
- smoking; tobacco; adherence; smoking cessation medications; nicotine replacement therapy; Bupropion; Varenicline; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1482313
- Identifier
- uon:50914
- Rights
- Copyright 2023 Amanual Getnet Mersha
- Language
- eng
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