Smoking cessation strategy in the national cervical cancer screening program (SUCCESS): study protocol for a pragmatic cluster randomised trial and process evaluation in Dutch general practice

Abstract

Introduction: Cervical cancer screening in general practice could be a routine moment to provide female smokers with stop smoking advice and support. The aim of this study is to assess the effect of a stop smoking strategy delivered by trained practice assistants after the cervical smear, and to evaluate the implementation process.

Methods and analysis: The study is a two-arm, pragmatic cluster randomised trial, in Dutch general practice. Randomisation takes place 1:1 at the level of the general practice. Practices either deliver the SUCCESS stop smoking strategy or the usual care condition. The strategy consists of brief stop smoking advice based on the Ask-Advise-Connect method and is conducted by trained practice assistants after routine cervical cancer screening. The primary outcome is the performance of a serious quit attempt in the 6 months after screening. Secondary outcomes are 7-day point prevalence abstinence, reduction in the number of cigarettes per day and transition in motivation to quit smoking. Follow-up for these measurements takes place after 6 months. Analysis on the primary outcome aims to detect a 10% difference between treatment arms (0.80 power, p=0.05, using a one-sided test), and will be performed according to the intention to treat principle. The process evaluation will assess feasibility, acceptability and barriers or enablers to the strategy's implementation. For this purpose, both qualitative and quantitative data will be collected via questionnaires and in-depth interviews, respectively, in both individual study participants and involved staff.

Ethics and dissemination: The Dutch Ministry of Health, Welfare and Sport approved of the trial after an advisory report from the Health Council (Nr. 2018/17). A licence was provided to conduct the study under the Population Screening Act. Study results will be disseminated through publications in peer-reviewed journals and conference presentations.

Trial registration number: NL5052 (NTR7451).

Keywords: preventive medicine; primary care; protocols & guidelines; substance misuse.

Figure 1

Flow chart for study participants of the SUCCESS study. Practice(s) = participating general practice(s). *Baseline questionnaire for all study participants from both treatment arms (intervention and control practices) = Questionnaire T1; Questionnaire at 2 weeks follow-up for female smokers participating in the intervention arm = Questionnaire T1B-S-I (T1B-smoker-intervention); Questionnaire at 6 months follow-up: for non-smokers in both treatment arms = Questionnaire T2-NS (T2-non-smokers), for smokers in the intervention arm = Questionnaire T2-S-I (T2-smoker-intervention), for smokers in the control arm = Questionnaire T2-S-C (T2-smoker-control). PA, practice assistant.