General PracticeResearchFramework
INTRODUCTION
Computer-tailored interventions can reach large sections of the population at a reasonable cost and are reported to be more effective in promoting behaviour change
than standard materials. The UK government-funded initiatives do not include the option of a tailored approach for smokers who do not want intensive counselling.
Therefore providing tailored feedback in primary care could complement existing services, helping to produce more quitters and reducing the UK smoking prevalence.
A large trial of the effectiveness of computer-tailored feedback delivered to smokers identified from general practice records and recruited proactively (ESCAPE) is in
progress, informed by a pilot study which demonstrated that recruiting smokers from general practice was successful in recruiting less motivated smokers, and
smokers with low literacy levels. The ESCAPE trial aims to target smokers from areas of high deprivation using a proactive recruitment strategy to deliver tailored
feedback to a large population. To ensure that the target population was reached, we used Carstairs scores which highlight deprivation within small populations, to
select a representative sample of practices from the UK General Practice Research Framework (GPRF) database. Here we describe the strategy used for the
recruitment of practices to the ESCAPE trial and the response.
METHOD
The MRC GPRF is a network of 1100 practices scattered throughout the UK. We aim to recruit 7250 smokers from 100 MRC GPRF practices selected to represent
high and low socio-economic areas. Two methods were used to encourage GPRF practices to self-select into the ESCAPE study:
1. Advertisement: The study was advertised in the GPRF Newsletters with an ‘Expression of Interest Form’ for completion.
2. Personal Invitations: Those who did not express an interest in the study through the adverts in the GPRF Newsletters were sent a personal invitation. In order to
ensure a good spread of practices, invitations were stratified by practice list size as shown below:
RESULTS
As a result of advertising, 98 GPRF practices originally expressed an interest in the study. However as a result of both methods above, 116 practices agreed to
participate in the study, yielding a high overall response rate of 23%. This recruitment strategy resulted in a good spread of practices from the quintiles as shown
below:
CONCLUSION
This recruitment strategy was successful in recruiting practices to the study and in recruiting practices from areas of high deprivation. Proactively recruiting smokers
from general practices shows promise as way to deliver public-health interventions to all sectors of the smoking population given the positive response to the study.
A Strategy for Targeting Smokers from High Deprivation Areas to a Computer-tailored Intervention using General Practice Records
Quintiles England Scotland Wales All
1 7 5 1 13
2 15 5 1 21
3 29 3 1 33
4 22 1 23
5 26 26
Total 99 13 4 116
As shown in the table, we managed to recruit a high proportion of practices in
quintiles 5 (most deprived) even though there were a small number of
practices within this quintile on the GPRF database.
After practices self selected into the study, they were selected for
participation after stratification for deprivation scores. Carstairs
scores were used to rank practice postcodes from least deprived to
most deprived, and wards were allocated to deprivation quintiles
according to equal fifths of the population. Therefore a proportional
selection was conducted from each quintile to ensure that the
proportion of surgeries selected from each ward was representative
of the population. For example, for England 7.6% of surgeries were
in quintile 1; 10.3% in quintile 2; 16.2% in quintile 3; 22.2% in quintile
4 and 43.4% in quintile 5. Therefore of the 86 English practices
needed, we hoped to recruit 7 from quintile 1; 9 from quintile 2; 14
from quintile 3; 19 from quintile 4 and 37 from quintile 5.
Region List size Nos. invited
East Anglia >3999 41 of 48
East Midlands >4999 38 of 67
North >3999 39 of 44
North West >3999 44 of 69
Yorks and Humber >4999 47 of 55
South East 4000 – 4999
8000 – 8999
12000 – 12999
>15000
66 of 219
South West 4000 – 5999
8000 – 11000
>13999
36 of 108
West Midlands 4000 – 6000
7250 – 9000
>12999
35 of 68
Scotland >4999 38 of 54
Wales ALL 31
Camille Alexis-Garsee1, Hazel Gilbert1, Irwin Nazareth1, Stephen Sutton2
1 University College London 2 University of Cambridge
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