Acceptability of integrating smoking cessation treatment into routine care for people with mental illness: A qualitative study

Katherine Sawyer, Kim Fredman Stein, Pamela Jacobsen, Tom P Freeman, Anna K M Backwell*, Chris Metcalfe, David S Kessler, Marcus R Munafo, Paul Aveyard, Gemma Taylor

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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INTRODUCTION: Improving Access to Psychological Therapies (IAPTs) Services could offer smoking cessation treatment to improve physical and psychological outcomes for service users, but it currently does not. This study aimed to understand participants' views and experiences of receiving a novel smoking cessation intervention as part of the ESCAPE trial (intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety). We used the Capability, Opportunity and Motivation Model of Behaviour (COM-B) to understand the (i) acceptability of the integrated smoking cessation treatment, (ii) views of psychological well-being practitioners' (PWPs) ability to deliver the smoking cessation treatment and (iii) positive and negative impacts of smoking cessation treatment.

METHODS: This was a qualitative study embedded within a feasibility randomized-controlled trial (ESCAPE) in primary care services in the United Kingdom (IAPT). Thirty-six participants (53% female) from both usual care and intervention arms of the ESCAPE trial, including both quitters and nonquitters, were interviewed using semi-structured interviews. Data were analysed using a framework approach to thematic analysis, using the COM-B as a theoretical frame.

RESULTS: Psychological Capability: Integrated smoking cessation treatment was acceptable and encouraged participants to reflect on their mental health. Some participants found it difficult to understand nicotine withdrawal symptoms.

MOTIVATION: Participants were open to change during the event of presenting to IAPT. Some described being motivated to take part in the intervention by curiosity, to see whether quitting smoking would help their mental health. Physical Opportunity: IAPT has a natural infrastructure for supporting integrated treatment, but there were some barriers such as session duration and interventions feeling segmented. Social Opportunity: Participants viewed PWPs as having good interpersonal skills to deliver a smoking cessation intervention.

CONCLUSION: People with common mental illness generally accepted integrated smoking cessation and mental health treatment. Smoking cessation treatment fits well within IAPT's structure; however, there are barriers to implementation.

PATIENT OR PUBLIC CONTRIBUTION: Before data collection, we consulted with people with lived experience of smoking and/or mental illness and lay public members regarding the aims, design and interview schedules. After analysis, two people with lived experience of smoking and mental illness individually gave feedback on the final themes and quotes.

Original languageEnglish
Pages (from-to)108-118
Number of pages11
JournalHealth Expectations
Issue number1
Early online date12 Oct 2022
Publication statusPublished - 20 Jan 2023

Bibliographical note

Funding Information:
Marcus Munafò and Gemma Taylor previously received funding from Pfizer, who manufacture smoking cessation products, for research unrelated to this study. No other authors have any potential conflict of interest to declare.

Funding Information:
The authors would like to thank everyone who took part in the ESCAPE Trial. This study was funded by Dr Gemma Taylor's Cancer Research UK Postdoctoral Fellowship (C56067/A21330).

Publisher Copyright:
© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.


  • Smoking cessation
  • depression
  • anxiety
  • IAPT
  • primary health care
  • qualitative


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