Engagement With Stop Smoking Services After Referral or Signposting: A Mixed-Methods Study.

Introduction: Screening for smoking when people interact with healthcare services and referral of those who smoke to stop smoking services (SSSs) is a key component of efforts to tackle tobacco use. However, little is known about what happens after someone is referred or signposted to SSSs.

Methods: As part of the Cessation of Smoking Trial in the Emergency Department (NCT04854616), those randomized to intervention (n = 505) were referred to local SSSs (along with receiving brief advice and an e-cigarette starter kit) and those randomized to control (n = 502) were given contact details for the same services (signposted). SSS engagement data were collected: (1) directly from participants and (2) from SSS, additional qualitative data came from 33 participant interviews.

Results: Engagement with SSSs was very low. 3.2% (n = 16) of those in the intervention group and 2.4% (n = 12) in the control group reported attending a one-to-one support session. From SSS data, engagement was also low with 8.9% (n = 43) of those referred engaging and 3.1% (n = 15) going on to quit with SSS support. The majority of the 24 intervention participants interviewed did not recall being contacted by an SSS.

Conclusions: Referral or signposting to SSSs within an Emergency Department-based trial resulted in very low levels of engagement. Barriers to engagement identified included participants not being contacted by SSSs and the support offered not meeting their needs.

Implications: Referral or signposting of those who smoke to SSSs from the Emergency Department resulted in low rates of engagement in this large multicenter randomized controlled trial. To better support those who smoke, it may be more effective for smoking cessation advice to be offered "in the moment" within clinical settings, and follow-up to be proactively offered rather than relying on people being motivated to contact the services themselves or engaging when contacted.