Associate Professor Jenny Bowman is a health psychologist within the School of Psychology at the University of Newcastle. The collaborative and generally multidisciplinary research she undertakes involves investigating the behavioural and structural determinants of health and well-being, and the development and evaluation of intervention strategies to influence those determinants. Her research focus is applied, and projects are often undertaken within ‘real world’ health and other community settings, and utilise mixed methodologies tailored to the research questions.
An enduring concern has been with reducing the harm arising from tobacco smoking, especially (relevant to the current Australian Rotary Health) for particularly high risk and vulnerable groups such as people with substance use or mental health problems. Associate Professor Bowman is a registered psychologist, a member of the Australian Psychological Society and the College of Health Psychologists. She is currently serving as a member of the Executive of the Australasian Society for Behavioural Health and Medicine and is the President of the Australasian Society for Behavioural Health and Medicine.
SUMMARY OF PROJECT:
Integrated smoking care linking mental health inpatients to community services: a randomised controlled trial.
Previous research suggests that 70% to 90% of mental health inpatients smoke, and that people with mental illness are more dependent smokers. For people with mental health conditions, smoking results in a significant health burden from smoking-related disease, reduced quality of life and increased financial hardship. While smoking has traditionally been largely ignored, the importance of addressing smoking within mental health settings is being increasingly acknowledged - promoted by a recognition that it is an important public health environmental health issue. A significant step towards a new approach to smoking within mental health settings, well-supported by a growing body of research, is the introduction of smoking abstinence. In NSW, mental health facilities are implementing Smoke Free Workplace Policy (SFWP): requiring smoking abstinence by staff and patients alike, necessitating the development of protocols and training to support both staff and patients, and highlighting the clearly related issue of smoking cessation intervention and need for action.
Research suggests that a comprehensive approach, utilising a range of evidence-based strategies, including the provision of a supportive smoke-free inpatient environment, motivational intervention and additional (extended) psychosocial support, together with pharmacological assistance (provided appropriately to meet the needs of such a highly dependent group of smokers), offers the best chance of achieving smoking cessation for mental health patients. A significant challenge as yet not addressed by research, however, is how to best provide 'access' to integrated smoking care for people with mental health conditions (in a manner which is feasible, acceptable and effective).
The aim of this project is to rigorously assess, by randomized controlled trial, the effectiveness of an integrated model of smoking cessation care for mental health patients, building upon the platform of SFWP and linking inpatient and community health services. The primary outcome will be smoking cessation, with a number of other secondary smoking-related outcomes also assessed, and comprehensive process evaluation and health economic analysis undertaken. The intervention includes three main components:
I. a brief pre-discharge motivational enhancement session
II. a tailoring approach to encourage participants to select from a range of community-based psychosocial support options which will include: a ‘quit smoking’ support group with adjunctive follow-up telephone counselling, extended provision of dose-appropriate combination NRT, and Quitline referral, and
III. linkage with, and smoking-related information provision to, the most common post-discharge referral points (general practitioners and community-based mental health services).
In comparison to standard care practices (control group), it is hypothesized that at each of three follow-up periods, the intervention group will evidence:
· higher rates of (validated) smoking cessation
· higher rates of quit attempts
· quit attempts of longer duration
· lower levels of nicotine dependence and
· reduced smoking behaviour
PROGRESS REPORT 2008:
A/Professor Jenny Bowman, A/Professor Amanda Baker, A/Professor John Wiggers & Professor Vaughan Carr
This exciting and innovative project is soundly designed and feasible. The research team draws together considerable experience and expertise, representing a group of multi-disciplinary collaborators already actively working together and publishing in this area. Outcomes will be of considerable significance, potentially providing a sustainable model of smoking care that could be implemented within mental health care Australia wide and indeed internationally.
Planning and development for this project has been proceeding productively, although some delay was experienced in:
• the process of ethics approval; and
• the implementation of smoke free policies in the mental health service.
Changes in senior management in the mental health service also incurred delays. Intervention planning and development is well underway. Recruitment and intervention delivery will commence in 2009. Additional funding to support the project is being sought from the Commonwealth Department of Health. Development and piloting of a computer assisted telephone interview (CATI) for collection of outcome data is currently underway.