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