The effectiveness of generic emails versus a remote knowledge broker to integrate mood management into a smoking cessation programme in team-based primary care: a cluster randomised trial

Nadia Minian, Sheleza Ahad, Anna Ivanova, Scott Veldhuizen, Laurie Zawertailo, Arun Ravindran, Claire de Oliveira, Dolly Baliunas, Carol Mulder, Corneliu Bolbocean, Peter Selby, Nadia Minian, Sheleza Ahad, Anna Ivanova, Scott Veldhuizen, Laurie Zawertailo, Arun Ravindran, Claire de Oliveira, Dolly Baliunas, Carol Mulder, Corneliu Bolbocean, Peter Selby

Abstract

Background: Knowledge brokering is a knowledge translation approach that has been gaining popularity in Canada although the effectiveness is unknown. This study evaluated the effectiveness of generalised, exclusively email-based prompts versus a personalised remote knowledge broker for delivering evidence-based mood management interventions within an existing smoking cessation programme in primary care settings.

Methods: The study design is a cluster randomised controlled trial of 123 Ontario Family Health Teams participating in the Smoking Treatment for Ontario Patients programme. They were randomly allocated 1:1 for healthcare providers to receive either: a remote knowledge broker offering tailored support via phone and email (group A), or a generalised monthly email focused on tobacco and depression treatment (group B), to encourage the implementation of an evidence-based mood management intervention to smokers presenting depressive symptoms. The primary outcome was participants' acceptance of a self-help mood management resource. The secondary outcome was smoking abstinence at 6-month follow-up, measured by self-report of smoking abstinence for at least 7 previous days. The tertiary outcome was the costs of delivering each intervention arm, which, together with the effectiveness outcomes, were used to undertake a cost minimisation analysis.

Results: Between February 2018 and January 2019, 7175 smokers were screened for depression and 2765 (39%) reported current/past depression. Among those who reported current/past depression, 29% (437/1486) and 27% (345/1277) of patients accepted the mood management resource in group A and group B, respectively. The adjusted generalised estimating equations showed that there was no significant difference between the two treatment groups in patients' odds of accepting the mood management resource or in the patients' odds of smoking abstinence at follow-up. The cost minimisation analysis showed that the email strategy was the least costly option.

Conclusions: Most participants did not accept the resource regardless of remote knowledge broker strategy. In contexts with an existing KT infrastructure, decision-makers should consider an email strategy when making changes to a programme given its lower cost compared with other strategies. More research is required to improve remote knowledge broker strategies.

Trial registration: ClinicalTrials.gov, NCT03130998 . Registered April 18, 2017, (Archived on WebCite at www.webcitation.org/6ylyS6RTe ).

Keywords: Knowledge translation strategies; Mood management intervention; Remote knowledge broker; Smoking cessation.

Conflict of interest statement

The authors declare that they have no competing interests concerning this manuscript. However, some authors have general disclosures to report. PS reports receiving grants and /or research support from the Centre for Addiction and Mental Health, Health Canada, Ontario Ministry of Health and Long-term care (MOHLTC), Canadian Institutes of Health Research (CIHR) , Canadian Centre on Substance Use and Addiction, Public Health Agency of Canada (PHAC), Ontario Lung Association, Medical Psychiatry Alliance, Extensions for Community Healthcare Outcomes, Canadian Cancer Society Research Institute (CCSRI), Cancer Care Ontario, Ontario Institute for Cancer Research, Ontario Brain Institute, McLaughlin Centre, Academic Health Sciences Centre, Workplace Safety and Insurance Board, National Institutes of Health (NIH), and the Association of Faculties of Medicine of Canada. PS also reports receiving funding and/or honoraria from the following commercial organisations: Pfizer Inc./Canada, Shoppers Drug Mart, Bhasin Consulting Fund Inc., Patient-Centered Outcomes Research Institute, ABBVie and Bristol-Myers Squibb. Further, PS reports receiving consulting fees from Pfizer Inc./Canada, Evidera Inc., Johnson & Johnson Group of Companies, Medcan Clinic, Inflexxion Inc., V-CC Systems Inc., MedPlan Communications, Kataka Medical Communications, Miller Medical Communications, Nvision Insight Group and Sun Life Financial. Through an open tender process, Johnson & Johnson, Novartis, and Pfizer Inc. are vendors of record for providing smoking cessation pharmacotherapy, free or discounted, for research studies in which PS is the principal investigator or co-investigator. NM and LZ report receiving grant funding from CIHR, CCSRI, Ontario MOHLTC and Pfizer Inc/Canada. All remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
STOP Portal levels of depression severity
Fig. 2
Fig. 2
CONSORT flow diagram

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