7.14 Methods, services and products for quitting—telephone advice and assistance
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7.14.1 Quitline service
The Quitline is a specialised telephone information and counselling service for people interested in smoking cessation. Each state and territory funds the service within its own jurisdiction, but the service is delivered in a different jurisdiction in some cases. All of the Quitlines have a common telephone number (13 7848 – 13 QUIT). Administrative arrangements for the services vary, some operating from within the state alcohol and drug treatment services, others based in non-government health organisations contracted to provide the service. All services operate to an agreed set of national minimum standards for such things as the range of services provided, response times for calls, data collection, and the training and qualifications of counsellors.255 There are also agreed protocols for supporting callers with special needs such as pregnant smokers, those with mental illness, young people and those from Aboriginal and CALD communities. In 2007, there were 117,174 calls to the Quitline throughout Australia, almost all of which were related to smoking cessation.
A significant advantage of the Quitline is that it provides equity of access in regard to income, different languages and location. For the price of a local landline telephone call (mobiles excepted), Quitline provides access to confidential advice, support, courses, self-help resources, and telephone counselling for smokers who want to quit. All calls to the Quitline are answered 24 hours a day. In some states and territories counsellors are available 24 hours a day, while in others they are available during the day and evenings, and will return calls to out-of-hours callers during counselling hours. The qualifications and experience of Quitline counsellors ensure that they understand smoking cessation issues and methods and can deliver a supportive and non-judgemental service consistent with national standards and protocols. They must be non- or ex-smokers and usually have tertiary qualifications in psychology, counselling or related fields, followed by induction training in smoking cessation issues and methods, with regular updates. Counsellors systematically record information on smoking history and previous quit attempts. They encourage smokers to set a quit date, and to maximise success by considering evidence-based methods, as well as their individual preferences and past history of quitting. They assist callers to deal with cessation issues such as withdrawal symptoms. Callers are encouraged to participate in a program of callbacks.
A comprehensive review of telephone counselling services throughout the world concluded that multiple sessions were more effective than single sessions.256 The effectiveness of the Australian Quitline service has been evaluated in several studies including in 1997/98, after its first year of national promotion as part of the National Tobacco Campaign. Callers rated the Quitline positively: 97% said it was either very or somewhat friendly, 86% helpful, and 82% said they would recommend it to friends. When callers were followed up for 12 months, 29% were found to be quit (point prevalence) although only 6% had been continuously quit over that time.250
More recent evaluations of the South Australian and Victorian services have been conducted. In South Australia, 88% of the callers sampled had made a quit attempt since their initial call to the Quitline. Of those that had made a quit attempt, 38% were stopped at six month follow-up. At the 12 month follow up, 96% said they had made a quit attempt, and 38% were stopped at the time of interview. Assuming that those who could not be contacted for follow up were all smokers, the conservative quit rate estimate would be 20%.257 In the Victorian evaluation, 83% of callers said they would recommend the service to a friend, and 84% said they would use the service again in the future if necessary.258 It is probable that these relatively high rates of cessation reflect the value of the Quitline's assistance, but callers are also likely to be more motivated and prepared than other smokers.
7.14.2 Callbacks
An important aspect of the Quitline operation is the proactive callback service. Callers who are intending to quit are encouraged to participate in the program, with the aim of increasing the success rate and reducing relapse over a period of about 12 weeks from the quit date. Once a smoker sets a quit date, a Quitline counsellor calls at agreed times to provide information, assistance to deal with barriers, and generally provide encouragement and practical support. Calls are typically scheduled closer together soon after the quit date and then are more widely spaced as the client progresses towards maintenance of their new non-smoker status.
Evaluation of the South Australian callback service at 12 month follow-up showed a higher point prevalence quit rate (47%) than callers who chose not to have the callback service (37%).257 A similar pattern was found in Victoria, where the benefit was found to be predominantly due to relapse prevention.259 The findings from these evaluations are in line with a comprehensive review of proactive telephone counselling, which found that it significantly improved quitting outcomes.256
The Quitline has also developed a variety of programs for special purposes, varying from state to state, and year-to-year depending on needs and funding. Examples include programs for people living with mental illness (especially depression), prisoners, pregnant women and partners, and cancer patients.
A further extension of the Quitline service through direct telemarketing to smokers has also been trialled with some success. A study in NSW found that such a cold-calling approach was acceptable to many smokers, especially if it offered subsidised nicotine replacement products as well as the current range of services.260
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