Implementing e-cigarettes as an alternate smoking cessation tool during pregnancy:A process evaluation in two UK sites

Smoking during pregnancy increases the risk of adverse maternal and foetal health outcomes, with effective smoking cessation support important. E-cigarette use in the general population has increased rapidly in recent years, with their use viewed as an alternate, additional offer to nicotine replacement therapy and behavioural support. However, their use in pregnancy has limited investigation. This study aimed to understand how two e-cigarette pilots for pregnant women were delivered and implemented. Referrals to the general stop smoking in pregnancy service, as well as pilot enrolment, engagement and outcomes were recorded. Seven professionals involved in pilot 2 design, setup and/or delivery took part in semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR). Transcripts were deductively coded into CFIR. In total, 124 of 296 women accessed at least one visit after being contacted and offered the e-cigarette pilot (Pilot 1: n=99, Pilot 2: n=25). In Pilot 2, 13 (of 25) reached 4 weeks and common reasons for withdrawal by 12 weeks included relapse, loss of contact, and no further support wanted. Forty-five (36.3%) validated quits were reported (Pilot 1: 32 of 99 (32.3%); Pilot 2: 13 of 25 (52%)). Facilitators included regular communication, and the advisors physically taking e-cigarettes to home visits. Barriers included misalignment between the pilot and the standard treatment offer and availability of staff resource. Enrolment to both pilots were demonstrated, with greater enrolment in one pilot and notable quit rates among women across both pilots. The perceived role of e-cigarettes for pregnant women varied and a lack of staff resource explained some challenges. Adaptations may be needed during scale up, including additional resource and alignment of e-cigarette provision to standard treatmen

Provision of E-Cigarettes for Smoking Cessation in Pregnancy:Perceptions and Experiences of Pregnant Women from Two UK Sites

INTRODUCTION: Smoking in pregnancy is associated with negative health outcomes for both mothers and babies; e-cigarettes, which contain nicotine without hazardous tobacco, may offer an additional smoking cessation strategy for pregnant women. Although e-cigarettes are being increasingly offered within services, there is limited understanding about whether e-cigarettes can improve smoking cessation support for pregnant individuals. This study aimed to explore service users' experiences of using e-cigarettes as a tool for smoking cessation during pregnancy.METHODS: Semi-structured interviews were conducted with 14 women who had accepted one of two pilots and were analysed using inductive reflexive thematic analysis. The findings from each site were integrated to develop qualitative insight.RESULTS: Participants largely had positive perceptions of the free and easy-to-use e-cigarette, preferring it to nicotine replacement therapies. The desire to have a healthy pregnancy and baby and the inclusion of non-judgemental behavioural support facilitated motivation to quit. Many participants reduced or quit tobacco use, with positive social and health implications reported. However, numerous barriers to quitting were present and intentions about long-term quitting of combustible cigarettes and e-cigarettes were mixed and uncertain.CONCLUSIONS: Providing e-cigarettes within smoking cessation services was indicated to be a positive and effective strategy for pregnant women trying to quit tobacco. However, numerous barriers to quitting and staying quit remained, suggesting scope for further improvements to smoking cessation support for pregnant women.</p

Multi-disciplinary Evaluation of Sexual Assault Referral Centres (SARCs) for better Health (MESARCH): protocol for a 1-year cohort study examining health, well-being and cost outcomes in adult survivors of sexual assault attending SARCs in England

INTRODUCTION Sexual violence is commonplace and has serious adverse consequences for physical and mental health. Sexual Assault Referral Centres (SARCs) are viewed as a best practice response. Little is known about their effectiveness and cost-effectiveness. Long-term data on the health and well-being of those who have experienced rape and sexual assault are also lacking. METHODS AND ANALYSIS This is a mixed-methods protocol for a 1-year cohort study aiming to examine the health and well-being in survivors of sexual violence after attending a SARC in England. Quantitative measures are being taken at baseline, 6 and 12 months. Post-traumatic stress (PTS) is the primary outcome (target N=270 at 12-month follow-up). Secondary measures include anxiety, depression, substance use and sexual health and well-being. Using mixed-effects regression, our main analysis will examine whether variation in SARC service delivery and subsequent mental healthcare is associated with improvement in trauma symptoms after 12 months. An economic analysis will compare costs and outcomes associated with different organisational aspects of SARC service delivery and levels of satisfaction with care. A nested qualitative study will employ narrative analysis of transcribed interviews with 30 cohort participants and 20 survivors who have not experienced SARC services. ETHICS AND DISSEMINATION The research is supported by an independent study steering committee, data monitoring and ethics committee and patient and public involvement (PPI) group. A central guiding principle of the research is that being involved should feel diametrically opposed to being a victim of sexual violence, and be experienced as empowering and supportive. Our PPI representatives are instrumental in this, and our wider stakeholders encourage us to consider the health and well-being of all involved. We will disseminate widely through peer-reviewed articles and non-academic channels to maximise the impact of findings on commissioning of services and support for survivors. TRIAL REGISTRATION NUMBER ISRCTN30846825

Care and support by Sexual Assault Referral Centres (SARCs) in England for survivors of sexual violence and abuse: a mixed-methods study (MESARCH)

Background: One million people in England and Wales experience sexual violence and abuse each year with around half experiencing serious sexual offences; 55,000 survivors access Sexual Assault Referral Centres (SARCs). Objectives: Our research was commissioned by NIHR to evaluate access, interventions and care pathways for survivors, specifically those provided through SARCs.Design, setting, participants: The SARC care pathway was investigated through six sub-studies. We conducted two Cochrane Reviews (4,274 participants). A process evaluation of SARCs interviewed 72 providers and 5 survivors at 8 sites; our children and young people (CYP) study involved 12 CYP from 2 SARCs. A cohort study with three waves of data collection over one-year (21 SARCs, 2,602 service users screened, 337 recruited) used a multilevel-modelling framework to explore risk factors for burden of post-traumatic stress disorder (PTSD) symptoms at baseline and change at one-year. We analysed costs and outcomes, and conducted an embedded narrative analysis (42 survivors). We prioritised the safety/welfare of participants and researchers and embedded lived expertise across the project lifecycle.Results: The Cochrane Reviews identified large effects from psychosocial interventions for PTSD and depression. SARCs delivered a high-quality frontline service for adult and young survivors, functioning as a gateway to onward services. Groups underrepresented at SARCs include those experiencing domestic abuse and some ethnic and cultural minorities. The research emphasised inter-agency/sector collaboration for survivor benefit. Supported by our qualitative research with minoritised groups, the cohort study showed a risk ‘triad’ with adverse childhood experiences, chronic mental health problems and economic deprivation. The research evidenced important improvements in trauma symptoms. These were unrelated to different SARC models and persisted for half of people a year later. Health-related quality of life was below population norms at baseline and high levels of service use were reported. Over the 12 month period, costs and outcomes were similar across SARC models and no significant differences were identified. Harmful encounters occurred in relation to police and justice practices/procedures for 25% of participants and our qualitative studies emphasised the vital interactions between experiences of justice and wellbeing. Good practice largely concerned enhanced communication (e.g. trauma-competent interviewing techniques; regular/timely updates; conveying case decisions with care). Limitations: The cohort study lacked a comparison group, reducing confidence in the finding that access to SARC and other health/therapeutic care explained the reduction observed in PTSD.Conclusions and future work: The risk ‘triad’ underscores the value of screening at SARCs and timely access to therapies/advocacy as part of multi-sectoral approach to supporting recovery. Poor mental health was the main barrier to service access beyond SARCs, suggesting the value of Independent Sexual Violence Advisors with mental health specialisation. The persistence of trauma symptoms supports calls for tackling wait-lists, expanding therapy options and commitment to lifelong care. Cohesive commissioning strategies can promote a whole pathway approach by supporting greater collaboration across providers. Access gaps at the population-level and for specific groups call for concerted efforts to support people to reach care early, for example, through outreach, campaigns and implementing trauma-informed universal health services. MESARCH provides a foundation for advancing trauma-informed practices when supporting people exposed to the effects of sexual violence and abuse<br/

Health and wellbeing of sexual abuse survivors attending sexual assault referral centres in England:the MESARCH mixed-methods evaluation

Background: One million people in England and Wales experience sexual violence and abuse each year with around half experiencing serious sexual offences; 55,000 survivors access Sexual Assault Referral Centres (SARCs).Objectives: Our research was commissioned by NIHR to evaluate access, interventions and care pathways for survivors, specifically those provided through SARCs. Design, setting, participants: The SARC care pathway was investigated through six sub-studies. We conducted two Cochrane Reviews (4,274 participants). A process evaluation of SARCs interviewed 72 providers and 5 survivors at 8 sites; our children and young people (CYP) study involved 12 CYP from 2 SARCs. A cohort study with three waves of data collection over one-year (21 SARCs, 2,602 service users screened, 337 recruited) used a multilevel-modelling framework to explore risk factors for burden of post-traumatic stress disorder (PTSD) symptoms at baseline and change at one-year. We analysed costs and outcomes, and conducted an embedded narrative analysis (42 survivors). We prioritised the safety/welfare of participants and researchers and embedded lived expertise across the project lifecycle.Results: The Cochrane Reviews identified large effects from psychosocial interventions for PTSD and depression. SARCs delivered a high-quality frontline service for adult and young survivors, functioning as a gateway to onward services. Groups underrepresented at SARCs include those experiencing domestic abuse and some ethnic and cultural minorities. The research emphasised inter-agency/sector collaboration for survivor benefit. Supported by our qualitative research with minoritised groups, the cohort study showed a risk ‘triad’ with adverse childhood experiences, chronic mental health problems and economic deprivation. The research evidenced important improvements in trauma symptoms. These were unrelated to different SARC models and persisted for half of people a year later. Health-related quality of life was below population norms at baseline and high levels of service use were reported. Over the 12 month period, costs and outcomes were similar across SARC models and no significant differences were identified. Harmful encounters occurred in relation to police and justice practices/procedures for 25% of participants and our qualitative studies emphasised the vital interactions between experiences of justice and wellbeing. Good practice largely concerned enhanced communication (e.g. trauma-competent interviewing techniques; regular/timely updates; conveying case decisions with care). Limitations: The cohort study lacked a comparison group, reducing confidence in the finding that access to SARC and other health/therapeutic care explained the reduction observed in PTSD. Conclusions and future work: The risk ‘triad’ underscores the value of screening at SARCs and timely access to therapies/advocacy as part of multi-sectoral approach to supporting recovery. Poor mental health was the main barrier to service access beyond SARCs, suggesting the value of Independent Sexual Violence Advisors with mental health specialisation. The persistence of trauma symptoms supports calls for tackling wait-lists, expanding therapy options and commitment to lifelong care. Cohesive commissioning strategies can promote a whole pathway approach by supporting greater collaboration across providers. Access gaps at the population-level and for specific groups call for concerted efforts to support people to reach care early, for example, through outreach, campaigns and implementing trauma-informed universal health services. MESARCH provides a foundation for advancing trauma-informed practices when supporting people exposed to the effects of sexual violence and abuse.Study registration: MESARCH is registered with ISRCTN registry ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825 Funding: Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research

Care and support by Sexual Assault Referral Centres (SARCs) in England for survivors of sexual violence and abuse: a mixed-methods study (MESARCH)

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