Feasibility of remote delivery of a smoking cessation intervention for people with severe mental illness: a telephone consultation
Authors: Ul Haq Baha , Aslam Faiza , Mazumdar Papiya , Reddy Sadananda , Sarfraz Mariyam , Murthy Nithyananda Srinivasa , Jackson Cath 
Published: September 2024

Background
The COVID-19 pandemic meant that face-to-face delivery of a smoking cessation intervention in India and Pakistan for people with severe mental illness within a feasibility trial was not possible. Rather than halt the feasibility trial, the decision was taken to adapt the intervention for remote delivery. This paper presents a telephone consultation conducted with key stakeholders to inform this adaptation.

Objective
To consult with key stakeholders on the feasibility, challenges and solutions for remote delivery of a smoking cessation intervention for people with severe mental illness in India and Pakistan.

Design
Rapid mixed-methods telephone consultation.

Setting
Two mental health facilities, one in Bengaluru, India, and the other in Rawalpindi, Pakistan.

Participants
Thirty-two members (16 India, 16 Pakistan) of Community Advisory Panels at the mental health facilities. Members were people with severe mental illness (2 India, 8 Pakistan), caregivers (3 India, 2 Pakistan) and professionals (11 India, 6 Pakistan).

Data collection and analysis
Questions explored general views on remote intervention delivery and specific feedback on nine intervention components (providing information, advising, asking questions, discussion, assessing motivation, using a flipbook, recording activities in a booklet, measuring exhaled carbon monoxide and administering medication). Telephone consultations were audio-recorded. Descriptive statistics were used for quantitative data, content analysis for qualitative data and then triangulated.

Results
All three participant groups identified challenges and solutions. Overall remote delivery was considered feasible with a preference for telephone sessions, supplemented with video, delivered for 30 minutes in the morning. Except for measuring carbon monoxide, all components were seen to be feasible, with more positive opinions evident in India. The key challenge related to achieving effective communication over the phone, especially for people with severe mental illness or low literacy. Access (connectivity and phone ownership) and monitoring medication use were other challenges. Popular solutions were to involve caregivers in all intervention components and to ensure these components and associated resources were appropriate for this patient group including those with low literacy. Based on this valuable feedback, the smoking cessation intervention was adapted for hybrid (remote and face-to-face) delivery instead of exclusive remote delivery with significant changes made to its delivery and content.

Limitations
This was a rapid consultation with a small sample of stakeholders. There were missing quantitative data in Pakistan.

Conclusions
Key stakeholders viewed remote delivery of the smoking cessation intervention among people with severe mental illness as feasible and particularly important when face-to-face delivery is not possible. The intervention was subsequently adapted for hybrid (remote and face-to-face) delivery.

Future work
Evaluating the feasibility and acceptability of hybrid delivery of this smoking cessation intervention was completed. A full trial commences in July 2024.

Funding
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/130.