Table_1_The value of compassionate support to address smoking: A qualitative study with people who experience severe mental illness.DOCX

IntroductionPeople experiencing severe mental illness (SMI) smoke at much higher rates than the general population and require additional support. Engagement with existing evidence-based interventions such as quitlines and nicotine replacement therapy (NRT) may be improved by mental health peer worker involvement and tailored support. This paper reports on a qualitative study nested within a peer researcher-facilitated tobacco treatment trial that included brief advice plus, for those in the intervention group, tailored quitline callback counseling and combination NRT. It contextualizes participant life experience and reflection on trial participation and offers insights for future interventions.
MethodsQualitative semi-structured interviews were conducted with 29 participants in a randomized controlled trial (intervention group n = 15, control group n = 14) following their 2-month (post-recruitment) follow-up assessments, which marked the end of the “Quitlink” intervention for those in the intervention group. Interviews explored the experience of getting help to address smoking (before and during the trial), perceptions of main trial components including assistance from peer researchers and tailored quitline counseling, the role of NRT, and other support received. A general inductive approach to analysis was applied.
ResultsWe identified four main themes: (1) the long and complex journey of quitting smoking in the context of disrupted lives; (2) factors affecting quitting (desire to quit, psychological and social barriers, and facilitators and reasons for quitting); (3) the perceived benefits of a tailored approach for people with mental ill-health including the invitation to quit and practical resources; and (4) the importance of compassionate delivery of support, beginning with the peer researchers and extended by quitline counselors for intervention participants. Subthemes were identified within each of these overarching main themes.
DiscussionThe findings underscore the enormity of the challenges that our targeted population face and the considerations needed for providing tobacco treatment to people who experience SMI. The data suggest that a tailored tobacco treatment intervention has the potential to assist people on a journey to quitting, and that compassionate support encapsulating a recovery-oriented approach is highly valued.
Clinical trial registrationThe Quitlink trial was registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines.

引言：重度精神疾病（severe mental illness, SMI）患者的吸烟率远高于普通人群，且需要额外的支持帮扶。现有循证戒烟干预措施（如戒烟热线、尼古丁替代疗法（nicotine replacement therapy, NRT））的参与率，可通过心理健康同伴工作者的介入与定制化支持得到提升。本研究针对一项由同伴研究者主导的烟草干预试验开展嵌套质性研究，该试验包含简短戒烟建议，且为干预组受试者提供定制化戒烟热线回电咨询与联合尼古丁替代疗法。本研究还原了受试者的生活经历与对试验参与的反思，并为未来的干预措施提供了参考视角。

方法：本研究在29名随机对照试验受试者完成招募后2个月的随访评估后开展质性半结构化访谈，其中干预组15人、对照组14人；此次随访标志着干预组受试者的"Quitlink"干预阶段结束。访谈内容涵盖受试者在试验前及试验期间寻求戒烟帮扶的经历、对试验核心环节的认知（包括同伴研究者提供的协助与定制化戒烟热线咨询）、尼古丁替代疗法的作用，以及所获得的其他支持。分析过程采用通用归纳法。

结果：本研究共提炼出四大核心主题：（1）在生活秩序紊乱的背景下，戒烟之路漫长且曲折；（2）影响戒烟的各类因素，包括戒烟意愿、心理与社会层面的阻碍因素、戒烟助力因素与戒烟动因；（3）定制化干预模式对精神健康问题患者的感知益处，如戒烟倡议与实用资源支持；（4）共情式支持交付的重要性，该模式由同伴研究者启动，并由戒烟热线咨询师为干预组受试者延伸支持。各核心主题下均细分出子主题。

讨论：研究结果凸显了目标人群所面临的挑战之艰巨，以及为重度精神疾病患者提供烟草干预时需考量的关键要点。数据表明，定制化烟草干预措施可助力受试者踏上戒烟之路，而涵盖康复导向理念的共情式支持也广受认可。

临床试验注册：Quitlink试验在首位受试者招募入组前，已在澳大利亚新西兰临床试验注册中心（Australian and New Zealand Clinical Trials Registry, ANZCTR，www.anzctr.org.au）完成注册，注册编号为ACTRN12619000244101，并按照注册指南定期更新信息。