Results

Table 1: Attendance numbers for Take Control Group Series sessions                                              

In the program's design, 60 minutes were allotted per session. In both of the TCGS, the group leader observed that more time was required in order to facilitate group discussion or for topic content presentation during the sessions, with the exception of the introductory session. Some of the unplanned content discussion included nutritional supplements, alternate nicotine replacement therapies, and relapse prevention techniques.

The TCGS leader observed that attendees at all sessions participated in the practical skills activities taught at the sessions. When asked about the barriers and facilitators to program delivery, the TCGS leader identified internal and external factors.

Barriers:

• Insufficient time allotted to meet program and client needs
• The presence of H1N1 pandemic influenza in the community (during October 2009 TCGS)
• Renovation activities at the Portsmouth Ave building

Facilitators:

• Location centrality
• Good group dynamics
• Excellent presenters
• Provision of nicotine replacement therapy (NRT) voucher
• 2 group leaders at session at October TCGS

From the perspective of the TCGS leader, no change to the series content was required. It was recommended the time allotment should be increased to 90 minutes per session to ensure adequate opportunity for both content presentation and group discussion.

Table 3.2: Perceived helpfulness of session content of each TCGS session (%)

Table 4: Distribution of smoking cessation stages of change at pre-intervention and post-intervention

n/a = not applicable to pre-intervention group because was not measured or was unable to measure

Of the 17 respondents who completed the post-intervention questionnaire, 2 were excluded in the comparison of stage of change at pre-intervention and post-intervention because pre-intervention data was missing. Tables 5 outlines the participants' movement through the stages of change from pre-intervention to post-intervention. Overall, 3 respondents moved in a positive direction, 5 moved in a negative direction, and 7 remained unchanged. The observed changes were not statistically significant (z= -.359, p=.72). One-third (5/15) of participants were at the preparation stage by the end of the TCGS.

Table 5: Comparison of pre-intervention and post-intervention stages of change (N=15)

A Wilcoxon test was used to determine whether there was a change in the levels of importance, confidence, and readiness to quit smoking at post-intervention (Table 6). The results indicated that among the 13 participants who completed both pre -and post-intervention questionnaires, there was a significant increase in participants' confidence to quit smoking at post-intervention. The mean of the ranks of increased confidence to quit was 6.61, while the mean of the ranks of decreased confidence to quit was 3.25. There was no significant change found in the importance of     quitting smoking or in respondents' readiness to quit smoking at the end of the TCGS compared to pre-intervention measures.

Table 6: Importance, confidence and readiness to quit smoking scores (1= not at all; 10=extremely)

*  Significant at p < .05

No respondents with a positive change in stage (n=3) reported a decrease in level of importance, confidence or readiness to quit smoking; 1 respondent did not complete the respective questions at post-intervention. Among those with a negative change in stage (n=5), 1 respondent reported a decrease in the importance to quit, and 2 respondents reported a decrease in confidence to quit and a decrease in readiness to quit. In the group with no change in stage (n=7), 2 respondents did not complete the post intervention questions about importance, confidence, and readiness to quit. Two respondents reported a decrease in readiness to quit, and no respondents reported a decrease in importance or confidence to quit smoking.

Table 7 outlines the descriptive statistics for the importance scores of each session at pre- intervention and post-intervention. For most sessions, participants scored the importance of the information as high at both pre-intervention and at post-intervention.

Table 7: Importance scores for session information scores (1= not at all; 10=extremely)

Nicotine addiction and cessation medications session

The importance of learning about nicotine addiction and quit smoking medications was rated at 8 or above by the majority of respondents at pre-intervention (62.8%, 22 and 64.7%, 22 respectively). Similarly, at the conclusion of this session, a large proportion of respondents rated the importance of learning about nicotine addiction and quit smoking medications at 8 or above (88.3%, 30 and 69.4%, 25 respectively).

At the conclusion of the session, the median score for respondents' confidence to explain nicotine addiction to someone else was 8.00 (n=36); with 22 respondents (61.3%) scoring their confidence level at a 7 or 8. The majority of respondents (94.4%, 34) indicated that they were likely to use the information learned in the session to help them quit smoking, with approximately 2/3 of respondents (n=24) expressing they were very likely to use the information from the session to quit smoking. At the conclusion of the program, 50% (n=8) of respondents used the nicotine information more than once a week during the program, while 40% (n=6) used the quit smoking medication information just a few times (Figure 2).

Breathe better session

Approximately 88% (n=31) of respondents at pre-intervention rated the importance of learning to breathe better at 8 or higher, and at post-intervention 96.2% (n=25) identified the importance of learning the information presented in this session at 8 or higher. Concerning their level of confidence to perform the breathing exercises taught during this session, the majority of respondents (84.6%, 22) rated their confidence as high (> 8).

All respondents (N=26) were somewhat likely or very likely to use the better breathing information to help them in their quit smoking process. Upon conclusion of the TCGS, approximately 2 out of 3 respondents drew upon the information they learned more than once a week or everyday (Figure 2).

Stress relaxation session

Most respondents at pre-intervention (82.8%, n=29), rated the importance of learning about how to reduce stress at 8 or above. By post-intervention, three-quarters of respondents (n=21) rated the importance of this information and their confidence in practicing stress relaxation at an 8 or above.

A large majority (92.8%, n=26) of respondents identified that they were likely to use the information learned at the stress relaxation session while they tried to quit smoking.

Approximately half of respondents (52.9%, n=9) reported using the stress relaxation information

more than once a week or every day over the course of the TCGS (Figure 2).

Healthy Eating

The majority of respondents (82.9%, n=29) at pre-intervention, rated the importance of learning about healthy eating at 8 or above. The high level of importance of this information was observed at post-intervention with 91.6 % (n=11) of respondents scoring it at 8 and above. Overall, respondents level of confidence in preparing healthy snacks was mostly high with 88.4% (n=10) scoring it at 8 and above.

When asked at the conclusion of the healthy eating session whether they would use the information they had learned, all respondents (n=12) indicated they were very likely. Approximately, 60% (n=10) reported using the information more than once a week or every day in the previous weeks (Figure 2).

Physical activity session

A large proportion of respondents (84.9, 28) rated the information about physical activity at 8 or above at pre-intervention. Again, the majority of respondents at post-intervention, about 68% (n=13), scored the physical activity information at 8 or above. At the end of the session about 3/4 (n=14) of respondents rated their confidence to use physical activity as part of a quit smoking cessation program at an 8 or above. At the end of the physical activity session, approximately 90% of respondents (n=14) were likely (somewhat likely or very likely) to use the physical activity information in the quit smoking process. The majority of respondents who provided feedback at the conclusion of the program (77.8%, 14) reported they used the physical activity information in the previous weeks, more than once a week and every day (Figure 2).

Quitting strategies session

At pre-intervention, almost all respondents rated the importance of learning about quitting strategies at an 8 and above (91.5%, 32). Also, at post-intervention the majority still scored the importance at 8 and above (90.9%, 20). Most respondents were confident at post-intervention about using the quit strategies, with about 82% (n=18) scoring the confidence level at 8 and above. Again, the majority of respondents at post-intervention were somewhat likely or very likely to use the information provided. Two-thirds of respondents (n=10) at the conclusion of the program used the information gleaned from the quitting strategies session once a week or not every day but more than once a week (Figure 2).

 At post intervention, all participants who provided feedback about the TCGS program indicated that they were satisfied with the program; the majority identified being very satisfied (Figure 3).

At the conclusion of the TCGS, respondents provided feedback about what they liked most and least about the TCGS and provided suggestions for improvement (Appendix 6). The weekly topics with expert presentations and hands-on demonstrations were appreciated. Respondents liked the group format because it provided opportunity for open discussion with a "variety of people". The effective group leader was acknowledged for her supportive and non-judgmental approach. Not only did respondents highlight that the allotted time for sessions was insufficient, they were some who felt that the 8-week TCGS, itself, was not long enough. The two-week interruption in program delivery negatively impacted the continuous support expected by participants. Respondents' suggestions included increasing the length of sessions and the length of the TCGS, increasing the number of  guest speakers (e.g. include a lung specialist), and including the stages of grief as a topic area.