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      Smoke-Free Recovery from Trauma Surgery: A Pilot Trial of an Online Smoking Cessation Program for Orthopaedic Trauma Patients

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Smoking increases the risk of complications associated with orthopaedic trauma surgery, however delivery of care is low. Online interventions may provide needed smoking cessation care and promote abstinence. This study aims to examine the engagement, acceptability, and retention of an online smoking cessation program (Smoke-Free Recovery; SFR) among a sample of orthopaedic trauma patients, as well as themes around the smoking cessation process. A pilot study of SFR with 31 orthopaedic trauma patients admitted to a public hospital in New South Wales, Australia took place. Semi-structured telephone interviews were conducted following hospital discharge. Thematic analysis and descriptive statistics were used. Engagement was high with 28 participants accessing SFR during admission. Twenty individuals completed follow-up phone calls. Program acceptability was rated favourably. After discharge, changes in smoking habits were noted, with program retention low. Themes on program use included: lack of time or need for additional support; computer illiteracy or technology issues; feeling unready or too stressed to quit; or feeling they had reached the boundary of what could be learnt from the program. This study highlights the difficulties faced by patients following hospital admission, the lack of follow-up support received, and the need for consumer testing prior to roll out. Continuing to develop interventions to promote hospital-initiated cessation attempts that continue post-discharge should be a priority.

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          Most cited references 50

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          Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions

          Background Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence. Objective This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention. Methods We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence. Results We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = .004), setup (p < .001), updates (p < .001), frequency of interaction with a counselor (p < .001), the system (p = .003) and peers (p = .017), duration (F = 6.068, p = .004), adherence (F = 4.833, p = .010) and the number of primary task support elements (F = 5.631, p = .005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence. Conclusions Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adhere.
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            Online support for smoking cessation: a systematic review of the literature.

            To examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators. A systematic review and meta-analysis of the literature (1990-2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model. There was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4-2.3] increasing 6-month abstinence by 17% (95% CI 12-21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0-1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0-2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high. Interactive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites.
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              Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis.

              To clarify the evidence on smoking and postoperative healing complications across surgical specialties and to determine the impact of perioperative smoking cessation intervention.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                28 July 2017
                August 2017
                : 14
                : 8
                Affiliations
                [1 ]School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; amanda.baker@ 123456newcastle.edu.au (A.L.B.); John.Attia@ 123456newcastle.edu.au (J.A.); Zsolt.Balogh@ 123456hnehealth.nsw.gov.au (Z.J.B.); Luke.Wolfenden@ 123456hnehealth.nsw.gov.au (L.W.); Eliza.Skelton@ 123456newcastle.edu.au (E.S.); Billie.Bonevski@ 123456newcastle.edu.au (B.B.)
                [2 ]Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW 2305, Australia
                [3 ]Department of General Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
                [4 ]Department of Traumatology, John Hunter Hospital, New Lambton, NSW 2305, Australia; Natalie.Lott@ 123456hnehealth.nsw.gov.au
                [5 ]Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW 2170, Australia; Justine.Naylor@ 123456sswahs.nsw.gov.au (J.N.); iaharris1@ 123456gmail.com (I.A.H.)
                [6 ]South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, NSW 2170, Australia
                [7 ]School of Human, Health and Social Sciences, Central Queensland University, Brisbane, QSD 4000, Australia; c.doran@ 123456cqu.edu.au
                [8 ]Centre for Medicine Use and Safety, Monash University, Parkville, VIC 3052, Australia; Johnson.George@ 123456monash.edu
                [9 ]Hunter New England Population Health, Wallsend, NSW 2287, Australia
                Author notes
                [* ]Correspondence: Sam.McCrabb@ 123456newcastle.edu.au ; Tel.: +61-024-033-5713
                Article
                ijerph-14-00847
                10.3390/ijerph14080847
                5580551
                28788089
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                Public health

                smoking cessation, telemedicine, wounds and injuries, orthopedics

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