Understanding the implementation of a smoking cessation intervention for people experiencing homelessness: A process evaluation of the SCeTCH trial

IntroductionCigarette smoking is higher in people experiencing homelessness. The Smoking Cessation Trial in Centres for Homelessness (SCeTCH) was a two-armed cluster randomised controlled trial in 32 services for homelessness across Great Britain. We compared the provision of an e-cigarette (EC) starter kit with usual care (UC). Findings from the process evaluation, focusing on intervention implementation from the perspectives of staff at EC centres and researchers are reported. MethodsThe process evaluation involved qualitative interviews with staff (N=16) and participants (N=31), observations of intervention delivery (N=32), fidelity checklists (N=25) (at EC sites), training evaluations (N=160) and data collected within the main trial (at both EC and UC sites). Findings here are from EC sites. ResultsFindings suggest that it is feasible to deliver a smoking cessation intervention in these services. The EC intervention was largely acceptable to staff and the training we delivered was highly rated. Individual intervention components were delivered with high fidelity, with no differences by centre size or location, suggesting high transferability. ConclusionChallenges to future delivery of similar interventions may stem from lack of wider staff team buy-in and support, as well as challenges to time available when faced with more immediate service user needs.