Assessing the Preconditions for Communication Influence on Decision Making: The North American Quitline Consortium

Abstract

The network of North American quitlines is a loose confederation of telephone-based smoking cessation professionals, including smoking cessation counseling providers, funders, researcher and policy advocates. Each quitline has some leeway in the types of services it provides, and the purpose of this article is to identify factors that explain such choices. Representatives from quitline organizations responded to a survey regarding the importance of several items that were hypothesized to influence general intentions to adopt and implement new cessation methods. Results indicate that internal (to the quitline) constraints are positively associated with consensus processes and that implementation of practices in general was more likely if consensus processes were used. Unilateral decision making (one person within an organization makes decisions for the quitline on his/her own) was unrelated to either internal or external constraints and was negatively associated with adoption of quitline practices. Discussion focuses on factors that influence consensus decision-making processes beyond those investigated in the article.

Acknowledgments

The KIQNIC project is funded by Grant Number R01CA128638-04 from the National Institutes of Health to the University of Arizona Cancer Center. Additional support is provided by Cancer Center Support Grant (CCSG - CA 023074).

Notes

¹The CDC defines an adult smoker as a person aged 18 years and above who has smoked in excess of 100 cigarettes in his or her lifetime and smokes daily or occasionally (“some days”). Health Canada's definition includes people 15 years of age and older who smoke either daily or occasionally.

²The new warning labels in the United States also contain graphic images pertaining to the effects of smoking, and are scheduled to take effect in September, 2012 (pending the outcome of several litigations).

³In some jurisdictions, the state or province also contracts with a coordinating organization, which may be responsible for quitline oversight, negotiating the contract or subcontract with the service provider organization, and/or promotion and marketing of the quitline. In addition, some quitlines are funded by more than one organization, with the additional funder(s) typically being an agency from another level of government supporting a defined area of quitline operation (e.g., promoting the quitline to the general or specific populations). In other cases, a single funder organization contracts with both a primary and a secondary service provider organization. In most of these cases there is a single primary service provider with the secondary provider being engaged during periods of high call volume to handle overflow calls (e.g., when media campaigns or increases in tobacco taxes increase the demand for smoking cessation services). In another case, however, the primary service provider conducts intake and screens for eligibility and provides counseling for a small proportion of callers, while the “secondary” service provider conducts the vast majority of counseling calls.

⁴The Washington State quitline currently serves only smokers who are on Medicaid or who work for companies that contract privately with a quitline service provider, due to recent funding cuts. However, at the time of this study, the Washington State quitline provided smoking cessation counseling to all residents of the state of Washington.

⁵The number of quitlines has increased since the time of this study to 65.

⁶ Pavitt (1993) and Bonito and Sanders (2009), among others, have noted that communication likely has other effects (e.g., increase or decrease cohesion) even when decision making is circumscribed by task and contextual features. Here we confine ourselves to the relation between communication and group decisions.

⁷In fact, Gouran and Hirokawa (1996) noted that rational decision-making processes are not always characteristic of discussion. For example, in some cases participants focus less on the merits of particular solutions and more on interpersonal and egocentric issues. Our concern here is with more organizationally based constraints on decision making.

⁸We did not ask about majority-vote situations because our discussions with NAQC personnel suggested it was a very unlikely scenario.

⁹We used this approach because there is variation in the number of practices considered over a given time period and in the order in which they are considered.

¹⁰These instructions would seem to bias the study's premise because they exclude practices that were either summarily adopted or summarily rejected. We chose this language because of the concern that not all respondents would be aware of, and thus able to respond to questions about, obviously useful or unhelpful practices. Even so, there is no reason to believe that ones that were considered/discussed were rejected or accepted consensually.

¹¹Some of the data points were nested within organization (i.e., service provider or funder), but many were not. Although multilevel techniques can incorporate “singletons” (i.e., one observation per upper-level unit) in the sense that it provides relatively unbiased estimates for level-1 predictors, doing so overestimates between-group variance relative to within-group variance (Clarke, 2008).