Promoting change in multiple health risk behaviours: Including brief advice for alcohol harm reduction in the English stop smoking service

Risky lifestyle behaviours have a multiplicative impact on both the length and quality of peoples’ lives. In order to improve health outcomes and reduce social inequalities in these outcomes, behaviour change services are recommended by health care and public health professionals.There is evidence to show that engagement in more than one form of health risk behaviour is common at a population level (for example, many smokers and also engage in potential harmful levels of alcohol intake), yet currently, behaviour change interventions focus on change in a single risk behaviour (e.g. smoking cessation). As partaking in more than one health risk behaviour leads to a multiple, rather than an additive risk for poor health outcomes and in order to maximise the potential of the current infrastructure of behaviour change services, this research programme aimed to examine the feasibility of utilising an existing behaviour change service (smoking cessation) to also deliver an intervention for further behaviour change (alcohol harm reduction).A four step process was undertaken. Following the systematic review reported at the beginning of this thesis, a further series of reviews of the evidence base relating to intervention design and implementation were undertaken in order to inform the design of the research programme. Secondly, following an assessment of existing service processes and staff training needs, two studies were implemented. Study 1 was designed as a quantitative study of behaviour change in clients attending a stop smoking intervention into which a second intervention, to address excessive alcohol consumption was incorporated. For a variety of reasons, this study failed to generate sufficient data for the planned analyses to be conducted. Study 2, a qualitative analysis of stop smoking service practitioners perceptions about the feasibility of delivering this intervention, revealed, notwithstanding the initial training prior to the commencement of Study 1, the practitioners’ normative beliefs about alcohol consumption had affected their willingness to deliver the alcohol-related intervention. To support the incorporation of alcohol-related interventions into existing services more comprehensive training will be required, including the need to challenge the beliefs and values of health professionals