u sing concept mapping to explore strategies for smoking cessation for women with experiences of...
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USING CONCEPT MAPPING TO EXPLORE STRATEGIES FOR SMOKING CESSATION FOR WOMEN WITH EXPERIENCES OF HOMELESSNESS AND SERIOUS MENTAL ILLNESS
Katelyn Hurley MPH | Lara Carson Weinstein MD MPH
Marianna LaNoue PhD | Ronald Myers PhD | Randa Sifri MDThomas Jefferson University, Philadelphia PA
Breaking the Mold: Novel Approaches to Studying Homelessness142nd APHA Annual Meeting | New Orleans, LA | November 18, 2014
Supported by Grant #IRG 08-060-04 from the American Cancer Society.
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BACKGROUND - SMOKING AND SERIOUS MENTAL ILLNESS (SMI) People with SMI experience significantly increased
morbidity and mortality as compared to the general population often due to smoking related illness.1
People with schizophrenia smoke more heavily, have more severe nicotine dependence, and have lower quit rates compared to the general population.2
Multiple studies indicate that people with SMI want to quit smoking,3,4 there is low use of effective treatment and a lack of population specific smoking cessation programs.4
1. Tsoi DT, Porwal M, Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database Syst Rev. 2013; 2.
2. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: Is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007; 64(10): 1123-1131.
3. George TP, Wu BS, Weinberger AH. A review of smoking cessation in bipolar disorder: Implications for future research. J Dual Diagn. 2012; 8(2): 126-130.
4. Ferron JC, Brunette MF, Mchuco GJ, Devitt TS, Martin WM, Drake RE. Developing a quit smoking website that is usable by people with severe mental illnesses. Psychiatr Rehab J. 2011; 35(2): 111-116.
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OBJECTIVE
To engage a diverse group of stakeholders to identify and prioritize strategies for smoking cessation in formerly homeless women with SMI.
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COMMUNITY-BASED SETTING
Setting: Supportive housing sites serving people with experiences of homelessness and SMI
Study group Formerly homeless women with a diagnosis of a
serious mental illness
Staff at Pathways and Project Home 6
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CONCEPT MAPPING OVERVIEW
Group participatory process
Mixed methods
Qualitative - brainstorming
Quantitative - multidimensional scaling, hierarchical cluster analysis
Produces easily readable visual maps
Includes community in interpretation and planning
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CONCEPT MAPPING METHODOLOGY
Brainstorming Generating statements in response to a focus
question Sorting
Actual sorting of statement cards into categories Rating
Rate ideas in terms of relative importance and feasibility using Likert scales
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FOCUS QUESTION
“We want to develop a program to help people quit
smoking. What kinds of things should this
program include?”
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BRAINSTORMING RESPONSES Have one-on-one support Have a visual like smokers lungs
vs. non-smokers lungs Peer support- someone who has
been through it Medication Having a customized quit plan
for each individual Cut back on drinking alcohol Find a hobby or pick up a new
hobby to keep your mind off it Quit line Remind people about things that
get better (skin, smell, taste, teeth, health problems)
Call it a research group rather than a smoking cessation group
Help people to understand the
importance of quitting Show people how quickly health
benefits can start when you quit smoking
Have a plan for what to do to fill in the space/time that used to be spent smoking
Have a plan for how to cope with stress/triggers
Show people how much money they have spent on cigarettes
Have people exercise to show them how difficult it is to breathe
Have a health coach Have an educational component
focusing on addiction 11
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BRAINSTORMING RESPONSES (CONT.) Hypnosis Acupuncture Don’t buy cigarettes Chew tobacco Give yourself a reward for smoking
less cigarettes in a day Separate out your cigarettes – how
many you want to smoke each day Smoke only half a cigarette and
then put it out Every time you smoke a cigarette
write it down Have a speaker with lung
cancer/throat cancer Have someone to call if you are
thinking of smoking/ a smoker’s hotline
Exercise Swimming Yoga Read the Bible Group therapy Say no to smoking in my house Getting a reminder to put my
patch on Go to the doctors Take away the shame of smoking Help people understand the role
that cigarettes play in their lives Have something to replace the
cigarettes (for example, ‘drink water,’ ‘eat an apple’, hard candy, lollipops, lozenges, cinnamon stick)
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SORTING AND RATING - CLIENTS
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SORTING AND RATING - STAFF
Hello everyone,
Thank you for participating in our smoking cessation research project. We are now ready to have you complete the sorting and rating exercise. Please copy and paste the following link into your browser:
http://www.conceptsystemsglobal.com/smokingcessationstrategies/sort/rate
You should be prompted to self-register for the project. You can save and come back to your sorting or rating at any time. We will close sorting and rating on Monday, December 2nd at midtnight. Please finish your sorting and rating before that time.
Thank you!
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CONCEPT MAPPING ANALYSIS Similarity matrix
Shows number of participants who sorted each pair of statements together
Multidimensional scaling Locates each statement on a 2-D map
Points more proximal to each other were more frequently grouped together
Hierarchical cluster analysis Partitions points into clusters of more general
conceptual groupings
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RESULTS 16
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MEETINGS AND PARTICIPANTS
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Brainstorming
2 meetings with clients• 24 total
participants
1 meeting with staff• 9 total
participants
Sorting and rating
2 meetings with clients• 21 total
participants
Done online with staff• 9 total
participants
Map interpretation
2 meetings with clients• 22 total
participants
Staff interpretation communicated through email
Feedback 2 meetings with clients
21 total participants
Staff feedback communicated through email
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DEMOGRAPHICS Gender
Clients (n)
Female – 23
Male – 1*
Staff (n)
Female – 6
Male – 3
*Participant circled male on questionnaire - wrote in transgendered female
Age
Staff (n) Clients
(n)
21-29 (3) (1)
30-39 (2) (1)
40-49 (1) (7)
50-59 (2) (8)
60-69 (1) (7)
70+ (0) (0)
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Race
Clients (n)
Black/African American – 13
White – 8
Hispanic or Latino – 2
American Indian/Alaskan Native – 1
Staff (n)
White – 8
Hispanic or Latino – 1
SMOKING HISTORY20
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Never Smoked
Used to Smoke
Smoke 1-3 Cigarettes/Day
Smoke about 1/2 PPD
Smoke between 1/2 - 1 PPD
Smoke more than 1 PPD
0% 5% 10%
15%
20%
25%
30%
35%
40%
Smoking History Clients
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Try to quit in the past 12 months?
YesNo
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Used to smoke
Never smoked
0% 10% 20% 30% 40% 50% 60%
Smoking History Staff
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CONCEPT MAPPING RESULTS
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CLUSTER MAP
Alternatives to smoking
Provide rewards to help with smoking cessation
Personal steps to reduce smoking
Take action to reduce triggers
Provide Education and Support
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PATTERN MATCH: IMPORTANCE
staff clients
Provide Education and Support
Provide Education and SupportProvide rewards to help with smoking cessation
Provide rewards to help with smoking cessation
Personal steps to reduce smoking
Personal steps to reduce smoking
Alternatives to smoking
Alternatives to smoking
Take action to reduce triggers Take action to reduce triggers
3.00 3.61
3.86 4.30
r = 0.81
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PATTERN MATCH: FEASIBILITY
Staff clients
Provide Education and Support Provide Education and Support
Personal steps to reduce smoking
Personal steps to reduce smoking
Provide rewards to help with smoking cessation
Provide rewards to help with smoking cessation
Alternatives to smoking
Alternatives to smoking
Take steps to reduce triggers Take steps to reduce triggers
3.07 3.16
3.76 3.71
r = 0.87
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GO ZONE
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910 11
16
21 2225 35
53 54
80
91
93108122 125
2
35 6
13 15 2326
2728
303137
38
4045
46
48
49
50
55
56
6061
63
6667
70
7172
73
76
79
82
83
84
85 8894
99103
104
105
107
110111
114115116117
118123124
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1417
18
29
32
3334
36
39
41
43
44
51
52
57
58
5962
64
68 69
74
7886
8990
95
96
97
98
100
101
102
106
112120
1
12
19 20 244247
65
75
7781
8792109
113 119121
[All Statements]
4.66
3.94
1.93
Importance
2.28 3.49 4.25
Feasibility
r = 0.73
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6. Show people how quickly health benefits can start when you quit smoking15. Have a support team23. Help people to understand the importance of quitting26. Education and support for staff45. Support groups46. Talk to your doctor73. Create a treatment plan105. Education123. Remind people about things that get better (skin, smell, taste, teeth, health problems)
65. Read the Bible75. Quit line77. Pray87. Listen to music
10. Have an alternative reward that fits in with the person's routine16. Say no to smoking in my house53. Plan your day around being without cigarettes54. Take away the shame of smoking122. Don't buy cigarettes
39. Acupuncture112. e-cigarettes120. Have a smoke break in the middle of the meeting
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FINDINGS
All participants rated the clusters “Personal steps to reduce smoking” and “Provide education and support” as the most important and most feasible areas to address.
In general, clients rated “Personal steps to reduce smoking” as more feasible and more important to address than staff.
“Take action to reduce triggers” was not rated as feasible or important to address by both staff and clients.
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TAKE ACTION TO REDUCE TRIGGERS7. Reading
25. Get enough sleep
27. Group outings
44. Chew tobacco
52. Change from coffee to tea
60. Set goals (for example, only smoke outside)
93. Save your money and buy something else with it
98. Hide your money
100. Cut back on drinking alcohol
101. Hide your cigarettes
112. e-cigarettes
120. Have a smoke break in the middle of the meeting
121. Relaxation/Meditation classes
8. Have a plan for how to cope with stress/triggers
66. Focus on small steps31
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LESSONS LEARNED
The importance of the focus prompt Easy to brainstorm ideas, however participants had a
difficult time sub-categorizing statements (sorting)
Clients need support in sorting
Client population very enthusiastic about participating in the project
Less interest from staff due to time constraints Lots of ‘tracking down’ with the web-based version
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FUTURE DIRECTIONS
Currently piloting a mammography decision support program for women with SMI
Considering feasibility of multibehavior change intervention targeting smoking and breast cancer screening
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THANK YOU!34
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