The effectiveness of a nurse led intensive community based smoking cessation protocol in quitting smoking in women smokers

Abstract

Background: Women smoking is a critical world health concern. Women are special risk group of smoking because approximately 1 million women died from tobacco-induced diseases worldwide each year and this number was increasing rapidly (Wesley and Sternbach, 2008). Besides, smoking increased the prevalence of menstrual irregularity, intermenstrual bleeding, varied length of menstrual cycle, pain and discomfort during menstruation of women (McEwen, 2006). Moreover, smoking will not just affect women but their children. Smoking is related to miscarriage, bleeding, premature rupture of the membranes, premature birth, growth retard baby, still birth, birth defects (The University of Hong Kong, 2007). Researches proved that combining telephone counseling and nicotine replacement therapy (NRT) are needed to help quitting smoking in women (Palmer, 2000). Quitting smoking can greatly reduce the chance of smoking associated diseases. Risk of lung cancer will be reduced by one-half to two-thirds after 10 years of abstinence and the risk of cardiovascular diseases (CVD) will be reduced by half within 1-2 years (Lewis, 2010). Nurses are the largest group of health professionals who work with people of all ages and community settings, so they should have enormous potential in helping people to quit smoking. As a result, it is important for nurses to understand more about this combined approach for quitting smoking in women smokers and translate the research evidence to real world practice in Hong Kong.

Purpose: The aims of this paper are to investigate the barriers to quit of women smokers in Hong Kong and their needs, to find out the gap between current and proposed smoking cessation services, to explore the relevant studies about smoking cessation in women smokers, to perform the quality assessment of selected studies, to summarize and synthesis the extracted data, to translate the existing data into a practice guideline that can be used in community setting for women smokers, to assess the implementation potential of the proposed guideline and to formulate an implementation and evaluation plan for the proposed guideline.

Methods: A total of 7 studies focusing on quitting smoking of women smokers located in Medline (1950- ), EMBASE (EMBASE Classic + EMBASE 1947- ) and Pubmed (1950- ) were selected. Thirty-day point prevalence quit rates at 12-month follow-up was used as the major outcome indicators. After quality assessment and extracting data from the related literatures, a practice guideline will be synthesized and the implementation potential will be assessed. The guideline will be graded according to the Scottish Intercollegiate Guidelines Network system. The implementation potential of the guideline will be assessed according to: (1) the transferability of the guideline, (2) the feasibility of implementing the guideline, and (3) cost-benefit ratio of the innovation. Then, the nurse led intensive community based smoking cessation program will be developed. An effective communication with all stakeholders is important in developing a positive relationship and to gain their support throughout the implementation of the proposed innovation. Pilot test will be conducted to test the satisfaction level of the innovation among women smokers in the real world setting, to test the feasibility of the innovation in the real world setting and to measure the actual material cost and non-material cost of the innovation. Am improvement plan will be drawn after evaluating the pilot test. After implementing the innovation, three outcomes evaluations will be used to evaluate this nurse led intensive community based smoking cessation program which include patient outcome, staff outcome and system outcome. The above results will be reported within one month after the innovation. The report can act as a useful guide for running similar smoking cessation programme in the future.

Conclusion: The proposed programme is recommended in the community setting to assist women smokers to quit smoking which is an important public health issue.