Implementation of brief stop smoking advice at cervical cancer screening in general practice: a process evaluation

Cervical cancer screening has potential as a teachable moment for smoking cessation. Smoking is a recognized risk factor for persistent high-risk human papillomavirus infection of the cervix and the development of cervical neoplasia. The cluster randomized SUCCESS trial tested brief stop smoking advice from practice assistants (PAs) after cervical screening in Dutch general practice. This process evaluation was conducted in parallel with the trial, aiming to evaluate the acceptability, feasibility, and implementation using a mixed-methods approach. Among the women who smoked, 72.9% found the advice acceptable or neutral, while future screening intentions remained high (98.1%). PAs deemed the approach feasible, with 21–45% planning post-trial maintenance. COVID-19 and low smoking prevalence limited uptake, however. Key facilitators for implementation include PA training, integrating cessation into routine consultations, team engagement and support, and prevention prioritization. Integrating smoking cessation into population-based cervical screening appears acceptable and feasible, but sustainable deployment of PAs into stop smoking care in primary care requires training and workflow integration.