Background To further develop effective smoking cessation interventions within mental healthcare for people with severe mental illness (SMI), it is essential to gain insights into patients’ experiences with smoking (cessation), and professionals’ experiences with guiding patients in overcoming tobacco addiction. Methods We conducted 26 semi-structured interviews with 16 patients and 10 mental healthcare professionals (MHPs), as part of a one-year smoking cessation intervention. A purposive sampling strategy was applied to select the interviewees. All interviews were transcribed verbatim and thematically analysed using MAXQDA software. This study was embedded in a randomised controlled trial conducted in ambulatory mental healthcare in the Netherlands. Results Patients reported to smoke to cope with psychological distress and psychiatric symptoms, and to alleviate potential side effects of antipsychotic medication. For some patients low self-esteem and a lack of confidence in one’s own capacity to quit smoking were obstacles to a quit attempt. Therefore, for those patients these were crucial aspects to address. Patients and MHPs valued the exercises based on cognitive behavioural therapy (CBT). During group sessions, establishing personalised relapse prevention strategies was regarded as effective preparation for a quit attempt. The group setting was welcomed, however, adjustments to individual needs and preferences are required to personalise the intervention. Conclusions Findings highlight the need for personalised care in treating tobacco addiction among people with severe mental illness. The KISMET intervention may serve as a useful framework for tailored cessation support, informed by the diverse experiences presented in this study.
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Background: There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Design: A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. Results: Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff’s motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. Conclusions: This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.
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