Introduction There is a need to develop strategies to increase the frequency with which smokers are identified and offered advice and support. There has been a call for more research on pharmacy-based smoking cessation.¹
Studies have shown that many smokers, especially those from low income groups, are not prepared to take action for their smoking yet the vast majority of programmes have been designed for those ready to take action. Smokers are often in the pre-contemplation or contemplation stages of the transtheoretical model.²
In a recent review of computer-tailored smoking cessation materials it was concluded that trials that combined tailored materials with nicotine replacement therapy (NRT) found a strong impact on smoking cessation and suggested further studies that examined the combined effects of tailored behavioural and pharmacological interventions.³
Public Management Associates, a not-for-profit organisation working with the public sector, has worked with Boots the Chemists and a number of health authorities and customised Prochaska, validated adult smokers, interactive, multimedia computer programme, Pro-Change. The programme is currently being piloted in Northumberland health action zone (HAZ) but is being rolled out to over 200 sites from June, 2000. Fifty Boots stores will have computer programmes, manuals and trained advisers and 150 stores will have manuals plus trained advisers. Computers will also be placed in GP surgeries and other sites, eg, leisure centres.
In the long term, the study has a number of objectives. It will ascertain the impact of the intervention on smoking cessation and smoking reduction, movement through the cycle of change, eg, from pre-contemplation to contemplation, sales of NRT, literature uptake, customer demand and commitment to the scheme, economic benefits, quality of access compared with other smoking cessation schemes, quality of provision, acceptability to customers and health professionals and the effects of the Pro-Change training. The study will determine whether the Pro-Change intervention is more effective in terms of access, retention and cessation rates than existing pharmacy and primary care interventions. It will determine whether the computer plus manual is more effective than the manual alone, and will determine whether pharmacy sites are more effective than other sites.

Method The four pilot computers are located in pharmacy (one) and primary care (three). The tailored interventions are validated health programmes capable of producing improvements in health status; they are backed up by a series of booklets and support from especially trained pharmacy and primary care staff.
The programme assesses the individual's readiness to change using the transtheoretical model and gives normative and iterative tailored advice. All the data is recorded on the computers as they are being used. Additional data regarding cessation rates, sales of NRT and so on are recorded separately.
Qualitative research is being carried on with the pharmacy, primary care staff and other stake holders - for example, health authority smoking lead, directors of public health and HAZ staff. We are exploring their views on Pro-Change and comparing it with other smoking cessation services.

Focal points

• Many people are not yet ready to stop smoking and require interventions to help them to consider stopping
• The vast majority of smoking cessation programmes are aimed at those ready to take action for their smoking
• Pro-Change, a validated adult smokers, interactive, multimedia computer programme based on the transtheoretical model of behaviour change (cycle of change) has been piloted in Boots the Chemist and primary care
• The programme is reaching a high proportion of low income and unemployed smokers
• Most users found the programme to be of benefit, easy to use and interesting.
• Preliminary data indicates movement through the cycle of change and an increase in cessation rates