Translating population-based smoke-free policy concerns into a pair-based tobacco cessation intervention: A multi-staged formative approach for developing a novel intervention

INTRODUCTION: Tobacco control has been most successful with population-based approaches such as smoke-free policies. Targeting individual behaviors is still necessary, but most adult cessation interventions do not address secondhand smoke concerns. We used a multi-staged, formative research to design, adapt and refine a novel household “pair-based” intervention with a smoker and nonsmoker for the clinical health education setting. METHOD: Our approach used three phases of focus groups which first interviewed a diverse general population and then targeted a high-risk population. Grounded theory was used after each focus group phase to refine and target interview questions. Focus groups were designed to assess feasibility of intervention strategies within a clinical health education setting and acceptability of specific intervention components. All groups were audio-recorded and iteratively analyzed. RESULTS: A total of 110 people participated in one of three phases of focus groups (n=13). 54% were smokers; 52% were female; 21% African American; 59% were Chinese-speaking immigrants. Phase 1 revealed preferences for intervention content, particularly communication strategies related to quitting and eliminating tobacco smoke exposure, and acceptability of biomarker feedback about smoke exposure. Phase 2 demonstrated preferences for intervention context, including acceptability of biomarker sampling methods, the pair-based intervention design, and refinement of messages about becoming smoke-free together and positive social support. Phase 3 focused the intervention design and messages for the target population, Chinese immigrants, who were selected to optimize an evaluation of the intervention's efficacy. CONCLUSION: A multi-stage formative process is useful in helping to develop a novel intervention with multiple components.