Research informing policy: Designing a tailored, patient-centered smoking cessation program

Background The National Institute of Health has delineated the need for tailored tobacco cessation interventions. However, guidelines for developing population-specific programs are lacking. Current VA tobacco control efforts appear to be less effective for women veterans than for their male counter-parts. Given an expected increase in the caseload of women veterans with tobacco-related morbidities, developing effective smoking cessation interventions for women veterans is an important goal. As there is little available literature about tailoring interventions for women, we used a consumer-driven approach to inform program design. Methods A professional moderator led a series of four concept-development focus groups convened to identify potential new smoking cessation interventions. Transcripts were reviewed and key themes identified. Guided by individual experts' knowledge of the literature and the focus group findings, a VA panel of experts (e.g. smoking cessation, women veteran's health, etc.) proposed a new program. Two additional focus groups provided feedback on program design. In a pilot study, a program brochure was mailed to 318 women veteran smokers; responses were analyzed as part of the process evaluation. Results Key focus group themes (critical components of an ideal program) included support and choice, which suggested the need for a personalized program. The Expert Panel designed an individualized menu-driven smoking cessation program that included five programs as well as a variety of quit and support tools. These menu options were incorporated into the WOW (Woman-to-Woman) Stop Smoking Toolkit Brochure which was positively evaluated by the concept-testing focus groups. In the pilot study, we found that women who completed the brochure (30) selected multiple menu options, demonstrating enthusiasm for program components. Top program choices included telephone counseling and a women-only program; the traditional VA program was the least selected program option. Conclusions Patients can be effectively involved in intervention development. Women veterans appear to prefer smoking cessation interventions other than the male-dominated program that is currently offered. Identifying appropriate components is critical to the development of efficacious smoking cessation programs that target women smokers. The use of focus groups and an expert panel may be appropriate for designing additional types of tailored interventions for at-risk populations. Preliminary results from the pilot study suggest that this consumer-driven approach may serve as a paradigm for developing programs that have increased appeal to the target population. Further research is warranted. If substantiated, our approach may inform guideline development regarding how to tailor a program; thereby advancing NIH objectives.