Internet-Based Photoaging Within Australian Pharmacies to Promote Smoking Cessation: Randomized Controlled Trial

Background: Tobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18-30 years are relatively resistant to antismoking messages due to their widely held belief that they will not be lifelong smokers. Objective: To conduct a randomized controlled trial (RCT) of a computer-generated photoaging intervention to promote smoking cessation among young adult smokers within a community pharmacy setting. Methods: A trial was designed with 80% power based on the effect size observed in a published pilot study; 160 subjects were recruited (80 allocated to the control group and 80 to the intervention group) from 8 metropolitan community pharmacies located around Perth city center in Western Australia. All participants received standardized smoking cessation advice. The intervention group participants were also digitally photoaged by using the Internet-based APRIL Face Aging software so they could preview images of themselves as a lifelong smoker and as a nonsmoker. Due to the nature of the intervention, the participants and researcher could not be blinded to the study. The main outcome measure was quit attempts at 6-month follow-up, both self-reported and biochemically validated through testing for carbon monoxide (CO), and nicotine dependence assessed via the Fagerström scale.Results: At 6-month follow-up, 5 of 80 control group participants (6.3%) suggested they had quit smoking, but only 1 of 80 control group participants (1.3%) consented to, and was confirmed by, CO validation. In the intervention group, 22 of 80 participants (27.5%) reported quitting, with 11 of 80 participants (13.8%) confirmed by CO testing. This difference in biochemically confirmed quit attempts was statistically significant (χ21=9.0, P=.003). A repeated measures analysis suggested the average intervention group smoking dependence score had also significantly dropped compared to control participants (P<.001). These differences remained statistically significant after adjustment for small differences in gender distribution and nicotine dependence between the groups. The mean cost of implementing the intervention was estimated at AU $5.79 per participant. The incremental cost-effectiveness ratio was AU$46 per additional quitter. The mean cost that participants indicated they were willing to pay for the digital aging service was AU $20.25 (SD 15.32). Conclusions: Demonstrating the detrimental effects on facial physical appearance by using a computer-generated simulation may be both effective and cost-effective at persuading young adult smokers to quit

Combined effects of franchise management strategies and employee service performance on customer loyalty: a multilevel perspective

Although franchisee performance is likely to be influenced by franchisors’ management strategies, little is known about whether and how franchisors’ strategies affect franchisee employees’ performance. This study examines the combined effects of three franchisor management strategies, namely innovative culture, support services and autonomy on service performance of the franchisee store employees and the loyalty of their customers. Data were collected from a total of 38 employees and 679 customers of 25 franchisee stores. The study employs multilevel analysis on a nested data-set created by matching customer data with employee data for each store. The results reveal that customer loyalty of a franchisee store is positively influenced by the service performance of its employees and the support services received by the employees of the store from its franchisor. On the other hand, it has been found that franchisor management strategy such as innovative culture and autonomy negatively influence customer loyalty of the franchisee store. The paper discusses relevant theoretical and managerial implications of the findings

Mobile health apps to facilitate self-care: a qualitative study of user experiences

Objective: Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications (‘apps’) for consumers’ self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps. Materials and Methods: ‘Health app’ was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively.Results: Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26–35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers’ data. Conclusions: The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring using apps. Understanding the range of consumer experiences and expectations can inform design of health apps to encourage persistence in self-monitoring

Delivering a personalised smoking cessation intervention by community pharmacists in Western Australia : a randomised controlled trial

Background: Tobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18–30 years are relatively resistant to anti-smoking messages.Aims: This research project aimed to test a digital ageing intervention to promote smoking cessation among young adult smokers within a community pharmacy setting and explore the value of the unfunded intervention within pharmacy practice.The primary outcomes were efficacy of the intervention measured by quit attempts and nicotine dependence and the secondary outcomes were cost-effectiveness of the intervention from a health sector perspective and community pharmacy business viability.Methods: This research project was named ‘Pharmacy PAINT’ (Photo-Ageing INTervention) and was conducted in community pharmacies in Perth, Western Australia in two trials: i) a pilot study; ii) a full Randomised Controlled Trial (RCT).The research was underpinned by the Medical Research Council (MRC) – Framework for design and evaluation of complex interventions, to improve health and the complex intervention was delivered by a qualified, registered pharmacist.Young smokers, aged 18 – 30 years who randomly entered the pharmacy, either to have a prescription dispensed or purchase an OTC (Over the Counter) medication were eligible to be recruited for the research if they were English speaking and able to give informed consent, did not have beards, moustaches or facial accessories that couldn’t be removed, were available for phone survey follow-ups and were not using Nicotine Replacement Therapy (NRT) or taking nicotine dependence medications.Consenting participants were randomised into two groups: a control group and an intervention group with equal numbers in each. Allocation into the groups alternated weekly so that all participants recruited in any specific week received the same treatment.Participants in the control group received standard smoking cessation advice from a pharmacist-researcher. Participants in the intervention group received the same standard smoking cessation advice from the pharmacist-researcher but in addition, they were photographed and their images digitally aged, as a smoker and non-smoker and then invited to view the age-processed images.The intervention involved using a photo-ageing tool (APRIL® Age Progression Software, 3D age progression software based upon Canadian normative ageing data) to deliver the non-smoking message by exposing the young smokers to graphic images of the detrimental effects of smoking on their future facial appearance.Results: The pilot study recruited 50 participants, 25 allocated to the control group and 25 to the intervention group and participants were followed-up for a three-month period. The pilot study was conducted between February 2008 to December 2008 and the results informed the feasibility, recruitment strategy, outcome measure, effect size and attrition rate for the subsequent RCT.The RCT was conducted from January 2010 to June 2011 and involved 160 participants, with 80 allocated in each of the control and intervention groups. Participants were followed-up for a six-month period. At the final six-month follow-up, five (8%) in the control group declared that they had quit smoking, however, only one (1.3%) of these subjects was an objectively confirmed non-smoker (validated on carbon monoxide (CO) testing). For the intervention group, 22 (38%) declared they had quit, with 11 (13.8%) confirmed by CO testing. This difference in these proportions between groups was highly significant (p = 0.005 by Fisher’s exact test). Results for the change in nicotine dependence score using the Fagerström Scale, showed a greater proportion of the subjects in the intervention group moving to a lower smoking dependence score than the control subjects (p<0.0001).Total costs of implementing the intervention from a health sector perspective were AUD 366 or the equivalent of AUD 4.58 per participant (Table 7). With an additional 10 quitters in the intervention group compared with the control group (11 versus one respectively), the incremental cost-effectiveness ratio (ICER) was AUD 37 per additional quitter. Cost offsets of AUD 2,144 from a reduction in the health care costs of quitters resulted in the intervention potentially generating net total cost savings of AUD 1,778.Participants indicated a mean willingness to pay for the digital ageing service of AUD 20.25, which exceeded the mean cost per participant for delivering the service of AUD 4.58. This suggested the service may be viable if the customer was charged in the pharmacy if not subsidised by government. The median willingness to pay of AUD 20.00 was similar to the mean value. Ten respondents thought aspects of the service could be improved and so made the following recommendations: to also provide information on methods to quit; to also offer a support program; to also show the effects of smoking on major organs. Over 80% of participants said they would be more likely both to use the pharmacy to purchase future smoking cessation therapies and to use it more generally for other purchases. Over 80% of participants also thought their friends would be willing to pay for the service and the vast majority of participants said they would recommend photo-ageing to one or more friends who were smokers.CONCLUSION: Emphasising the link of smoking to the detrimental effects on skin and physical appearance using a personalised promotion intervention can be an effective motivator to persuade younger adult smokers to quit. This intervention can be proactively and economically delivered by a pharmacist as primary health care counselling in a community pharmacy setting

Does Employee Performance Affect Customer Loyalty in Pharmacy Services?

Purpose: Employees in community pharmacies play a far significant and distinct role compared to the employees in traditional retail stores. This paper examines the effects of employee performance on customer loyalty of pharmacy services. Design/methodology/approach: Data were collected through a self-administered survey filled in by the customers of 25 community pharmacies. A total of 679 completely filled-in questionnaires were analysed. The proposed model was tested through structural equation modelling using AMOS 22. Findings: Employee performance positively affects pharmacy customers’ perceived value, trust and loyalty. Perceived value and trust fully mediates the relationships between employee performance and customers’ attitudinal and behavioural loyalty. Unlike short term customers, the long term relational customers’ perceived value was found to have significant impact on their trust and behavioural loyalty. Research limitations: This study is based on the Australian community pharmacy industries; hence, caution must be exercised in the generalization of the results to other countries. The study has considered only perceived value and trust in examining the link between the employee performance and customer loyalty. Other variables such as commitment could possibly influence the link, which has not been considered in this study. Originality/value: The study contributes to the existing literature by focusing on how employee performance influences both attitudinal and behavioural loyalty of pharmacy customers. It shows empirical evidence that employee performance influences customers’ perceived value and trust en-route to influencing their loyalty. The study measures employee performance based on both empathy and service provider performance covering a broader spectrum of the construct

Preliminary findings of how visual demonstrations of changes to physical appearance may enhance weight loss attempts

© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. This study reports how showing a person an illustration of themselves following future weight-loss might impact on their actual future weight-loss. Weight was recorded weekly, 8 weeks before and 8 weeks after the intervention. A significant proportion of the 44 participants lost weight following the intervention: 17 vs. 29 (P = 0.01, chi-squared = 6.559). After the first 8 weeks, the mean change in weight was -0.32 kg [standard deviation (SD): 2.2, P = 0.37]. The weight change after the second 8 weeks was -0.94 kg (SD: 1.7, P = 0.001). The mean difference in weight losses between the two periods was -0.62 kg (SD: 2.1, P = 0.08)

Photoaging Intervention (PAINT): A proposal for a randomised controlled trial in Australian Primary Care

The adverse health impacts of tobacco smoking are adrain on national resources. This study will test anintervention to promote smoking cessation among youngadults aged 18-30years. The intervention will be deliveredwithin two settings in Australian health care; communitypharmacies and general practice. The new study builds onthe pilot data, reported here, which inform the feasibility,recruitment strategy, outcome measure, effect size andattrition rate. The new study is a randomised controlledtrial with 200 clients recruited from general practice andcommunity pharmacies in Western Australia

Using visual demonstrations in young adults to promote smoking cessation: Preliminary findings from a French pilot study

Background: A personalised, smoking cessation message was successfully delivered in Australian community pharmacies to motivate behavioural change in young smoking adults. Objective: The purpose of this pilot study was to test the acceptability and effectiveness of the innovative, proven smoking cessation intervention to another population of young adults with a higher prevalence of smoking and associated morbidities. Methods: Ninety eight university students in Paris, France were recruited to a pilot study (50 intervention: 48 control). All students received smoking cessation counselling sessions and half also received a visual demonstration of themselves, both as a lifelong smoker and non-smoker. Results: There was no statistical significant difference between the groups in smoking dependence at recruitment. At the three month follow-up, the proportion who had attempted to quit smoking were 37% (control) vs 46% (intervention). These percentages suggested a positive result for the intervention, although the difference was not statistically significant (p = 0.39). Conclusion: This is one of the first studies conducted in France using visual demonstrations combined with healthcare counselling to promote smoking cessation amongst young adult smokers. Further research, recruiting from the general French public, is needed to better understand if the innovative personalised health message can motivate young French adult smokers to quit