Plain English Summary
Background and study aims
Community pharmacists and smoking cessation advisors are currently experiencing a rapid expansion of their role providing front line services for the NHS. This is a direct result of policy which identifies pharmacies as being an easily accessible and cost effective platform for delivering health care. Smoking cessation is one of the earlier tasks given to pharmacists/smoking cessation advisers. While a large number of people who smoke passing through the NHS Stop Smoking Programme (NHS SSP) quit, a significant number of people do not. To date there has been very little research to find out the best ways of helping people to stop smoking in community pharmacies. This study tests whether a service improvement and training programme (called the STOP intervention) for pharmacy staff will improve the uptake and reduce dropouts in the NHS Stop Smoking Programme and improve quit rates.
Who can participate?
Current smokers aged 18 and over
What does the study involve?
The participating community pharmacies are randomly allocated to either the STOP intervention or to usual practice. STOP involves training for pharmacy staff and associated study materials (e.g. badges, posters). Usual practice involves only NCSCT training (Level 1 or Level 2 depending on staff experience). Smoker recruitment into the NHS stop smoking programme and quit rates are assessed at 4 weeks and continuous abstinence is assessed at 6 months.
What are the possible benefits and risks of participating?
Participating may improve smoker quit rates. There is no risk for those taking part in the study.
Where is the study run from?
1. 29 pharmacies recruited from the following five boroughs in London: Tower Hamlets, Newham, City & Hackney, Islington, Barking & Dagenham (UK)
2. 19 pharmacies recruited from Coventry (UK)
3. 12 pharmacies recruited from Wales (UK)
When is the study starting and how long is it expected to run for?
May 2017 to August 2019
Who is funding the study?
National Institute for Health Research (NIHR) (UK)
Who is the main contact?
Wai Yee James
Ms Wai Yee James
STOP Trial Manager
Yvonne Carter Building
58 Turner Street
A training and service intervention to optimise pharmacist-based treatment for smoking cessation: a cluster randomised controlled trial
Community pharmacists or smoking cessation advisors are currently experiencing a rapid expansion of their role providing front line services for the NHS. This is a direct result of policy which identifies pharmacies as being an easily accessible and cost effective platform for delivering health care. Smoking cessation is one of the earlier tasks given to pharmacists/smoking cessation advisers. While a large number of people who smoke passing through the NHS Stop Smoking Programme (NHS SSP) quit, a significant number of people do not. To date there has been very little research to find out the best ways of helping people to Stop Smoking in community pharmacies.
This study (called the STOP study) will test whether a service improvement and training programme (called the STOP intervention) for pharmacy staff (pharmacists who are smoking cessation advisers and other pharmacy support staff e.g. counter assistants who might not be trained in smoking cessation) in community pharmacies will improve the uptake and reduce dropouts in the NHS Stop Smoking Programme and improve quit rates. The STOP intervention has been developed through a systematic review of community pharmacy based interventions, a detailed qualitative study (REC ref 13/SC/0189), and refined following a pilot study (REC ref 14/LO/2162). The trialists will now test the STOP intervention in 60 community pharmacies in North East London, South London (Southwark and Lambeth), Warwick and South East Wales to see whether the intervention is effective and cost-effective in improving the uptake and reducing dropout in the NHS SSP and thereby improving quit rates.
South Central - Hampshire A Research Ethics Committee, 03/04/2017, ref: 17/SC/0067
Randomised; Interventional; Design type: Treatment, Education or Self-Management, Complex Intervention
Primary study design
Secondary study design
Cluster randomised trial
Patient information sheet
See additional files
Specialty: Primary care, Primary sub-specialty: Public Health; UKCRC code/ Disease: Other/ General symptoms and signs
The STOP trial is a pragmatic, cluster randomised controlled trial to assess the effect of the intervention on smoker recruitment into the NHS stop smoking programme and quit rates at four weeks and continuous abstinence at six months.
The community pharmacies (the cluster level) will be randomised to STOP training and service optimization intervention arm or usual care using stratified randomisation. The randomisation will be at the pharmacy level with 1:1 allocation ratio.
STOP is a complex intervention based on behavioural theory involving training for pharmacy staff and associated study materials (e.g. badges, posters). The intervention training focuses on team approach in delivering the NHS STOP smoking service.
The National Centre for Smoking Cessation and Training (NCSCT) offers a range of training, assessment and certification programmes for both clinical and non-clinical health and social care workers to become more skilled in smoking cessation. Control pharmacies will only receive NCSCT training (Level 1 or Level 2 depending on staff experience).
Primary outcome measures
Throughput, defined as number of smokers who join the NHS SSP, attend a treatment session and set a firm quit date i.e. a ‘treated smoker’ (TS)
Secondary outcome measures
1. 4 week retention rate, defined as proportion of treated smokers retained at 4 weeks i.e. a treated smoker is counted as ‘lost to follow up at 4-weeks’ (LFU4W) if, on attempting to determine the 4-week quitter status s/he cannot be contacted
2. 4 week quit rate, defined as proportion of smokers who quit smoking at 4 weeks from set quit date i.e. a ‘CO-verified 4-week quitter’
3. Continuous abstinence rate, defined as proportion of smokers who quit at 4 weeks (CO-verified) and remained so at 6 months
4. Effect of the training intervention on additional (routine) data provided by the consented service users
5. Satisfaction about the NHS SSP via questionnaire
6. Self-efficacy in smoking cessation delivery via questionnaire
7. Study recruitment and retention rates of pharmacies and pharmacy staff, reasons for non-participation and dropout, service user consent/recruitment rates for additional data collection and retention rates
8. Intervention training attendance and completion rates, reasons for non-attendance and dropout
9. Acceptability of intervention training and delivery in practice via questionnaire
10. Delivery of skills in practice at the pharmacy counter around engagement of service users into the NHS SSP via simulated client using checklist
11. Skills around retention of service users in pharmacy consultation room via audio-recording of consultations
12. Views and experiences about the STOP training and its delivery in practice
13. Views and experiences about the NHS SSP with a focus on engagement and retention, reasons for completion and non-completion of the NHS SSP
Health economic outcomes:
1. Cost data from advisers: time spent (in minutes) by advisers on smoker service user delivering the NHS SSP and taking individual consent for STOP study additional data collection procedures and carrying out the data collection e.g. saliva samples
2. Cost data from study researchers: cost of delivery of training to pharmacy staff and costs associated with delivery of training such as travel expenses, refreshments, room hire, use of printed materials, use of assistive technology; provision of financial incentive; attending feedback meeting with trainer
Overall trial start date
Overall trial end date
Participant inclusion criteria
NHS SSP eligibility criteria:
1. Current smokers aged 18 and above
2. All types of smoking (cigarettes, cigar, pipe)
Target number of participants
Planned Sample Size: 1320; UK Sample Size: 1320
Participant exclusion criteria
Exclusion criteria for community pharmacies and pharmacy staff:
1. Sites that lack the facilities for secure storage and transfer of the study data
2. Advisors who refuse GCP training
Exclusion criteria for service users who will be part of the study exploring individual participant level outcomes:
2. Unable to understand the STOP study service user information sheet and consent form
3. Unable/unwilling to give written informed consent for STOP study additional data collection procedures for detailed analysis
Note: The risks and benefits of nicotine replacement need to be explained to pregnant or breastfeeding women and to people who have unstable cardiovascular disorders according to usual practice in the NHS Stop Smoking Service. Neither varenicline nor bupropion should be offered to pregnant or breastfeeding women. Varenicline or bupropion may be offered to people with unstable cardiovascular disorders, subject to clinical judgement
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
29 pharmacies recruited from the following five boroughs in London: Tower Hamlets, Newham, City & Hackney, Islington, Barking & Dagenham
Trial participating centre
19 pharmacies recruited from Coventry
Trial participating centre
12 pharmacies recruited from Wales
NIHR Central Commissioning Facility (CCF); Grant Codes: RP-PG-0609-10181
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Planned publication in a high-impact peer reviewed journal.
IPD sharing statement
The datasets generated during and/or analysed during the current study will be stored in a non-publically available repository.
Intention to publish date
Participant level data
Stored in repository
Results - basic reporting