Use of contextual factors by lay health advisors to tailor brief cessation interventions

Background: Lay health advisors may play an important role in community-based tobacco cessation by providing advice and information about resources and support networks. Little is known about their experiences conducting brief cessation interventions in diverse, real world settings. Objective: To examine the intervention activities of community members trained to conduct brief cessation interventions. Methods: Six-week follow-up interviews were completed by 81 participants of a large-scale, randomized controlled trial which compared methods of training community members to conduct brief tobacco cessation interventions. Semi-structured interviews were conducted between February 2005 and January 2006. Interview questions addressed characteristics and reactions to recent brief intervention experiences. All interviews were tape-recorded, transcribed, and coded using Atlas.ti 5.0. Results: Although some participants indicated that they used similar approaches with all smokers, the majority of participants reported tailoring their intervention activities based on contextual factors. The main factors included relationship with the smoker, smoker characteristics (i.e., age, personality, light/heavy user, and motivation for quitting), location/setting, and timing. Participants who reported positive intervention experiences often attributed them to their abilities to tailor interactions with different smokers. Conclusion: To date, the potential impact of community-based cessation efforts has been underestimated. Applications of the lay health advisor model may increase the reach of tobacco cessation interventions to individuals who encounter barriers to obtaining assistance with quit attempts, including those with limited access to health care. Lay health advisors appear to engage smokers in everyday settings and exhibit creativity and flexibility, allowing them to tailor intervention approaches to diverse contexts.