None listed
Conditions
Brief summary
The TNT trial is a multicentre, cluster randomised controlled study that aims to examine the effectiveness and cost effectiveness of an organisational change intervention in reducing smoking rates among clients attending drug and alcohol treatment centres across Australia. Intervention and control treatment centres will be compared. Clients attending control group centres will continue to receive usual care. Clients (who consent to participate) in the control centres will complete online surveys about their smoking three times over a 6 month period. The intervention group treatment centres will receive organisational change interventions including assistance in smoking policy development, creating client champions, and staff training. Clients (who consent to participate) in the intervention centres will complete online surveys about their smoking three times over a 6 month period. Participating clients will also be offered brief smoking education, counselling and nicotine replacement therapy by the centre staff as part of their usual centre appointments. Intervention effectiveness will be measured by smoking cessation in the intervention versus control treatment centre clients at six weeks and six months follow-up. The primary outcome measure will be the client self-reported 7-day point prevalence abstinence at 6 weeks follow-up which will be biochemically verified.
Interventions
Participating drug and alcohol service sites randomised to the intervention group will receive an organisational change intervention program. The intervention will be delivered over a 3-month period (6-weeks prior to baseline recruitment; 6-weeks during baseline recruitment) and on-going support will be provided over the 6-month recruitment period. Intervention trial sites will participate in a ‘systems change’ intervention which aims to change organisational systems to improve delivery of smoki
Participating drug and alcohol service sites randomised to the intervention group will receive an organisational change intervention program. The intervention will be delivered over a 3-month period (6-weeks prior to baseline recruitment; 6-weeks during baseline recruitment) and on-going support will be provided over the 6-month recruitment period. Intervention trial sites will participate in a ‘systems change’ intervention which aims to change organisational systems to improve delivery of smoking cessation care and treatment to clients. ‘System-level changes’ integrate the identification of smokers and offering of cessation treatments into routine delivery of care. Strategies to achieve this will include: *Engaging organisational support: Trial site managers will be asked to support and advocate for smoking cessation changes in the workplace. This may include staff meetings and communications (newsletters, noticeboards, email) to engage staff and address barriers that may arise. *Identifying and support a ‘champion’: One staff member in each treatment centre will be nominated to take a lead role. S/he will assist other staff to deliver brief advice to clients who smoke, oversee the client surveys, and follow up client progress. Participating key staff members will meet regularly either face to face or by teleconference to exchange information and provide peer support. *Promoting centre policies that support and provide tobacco dependence services: Research staff will assist with creation of smoke-free policies, smoke-free signs, support for staff to quit and changes to processes to create a cessation-supportive environment. Services with existing policies will be provided with assistance to develop programs to maximise enforcement. *Implementing a system of identifying clients who smoke: The goal of this strategy is to make sure all clients are asked about tobacco use at every clinical encounter. This simple step has been shown to increase the rate that doctors intervene with smokers. *Providing education and resources: Training will be necessary to ensure staff members have the skills and information to assist their clients in making a quit attempt. A one-day workshop will be delivered by experienced smoking cessation trainers. *Including evidence-based tobacco dependence treatments: Resources such as QUIT Packs and QUITline will be made use of where appropriate. Nicotine replacement therapy (NRT) will be provided free of cost during treatment and in consultation with the clinic doctor. This intervention will provide a flexible range of NRT options (including inhalers which were found to be popular in our pilot study with non-government community service clients). Currently, subsidised NRT through the Pharmaceutical Benefits Scheme is available for prescription nicotine patches only.
Sponsors
University of Newcastle
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
In order to be eligible to participate in this study, an individual must meet all of the following criteria: *Client of the participating drug and alcohol service *Aged 16 years or older *Provide signed and dated informed consent form *Self-reported current smoker In order to be eligible to participate in the staff survey (to assess staff attitudes), individuals must meet the following criteria: *Staff member or person working in an identified volunteer role within a drug and alcohol service participating in the TNT project
Exclusion criteria
An individual who meets any of the following criteria will be excluded from participation in this study: *Client cannot communicate in English *Client with severe untreated mental illness as identified by treatment staff (in order to give informed consent) or in an agitated or aggressive state.
Outcome results
None listed