Aims

To investigate the comparative and combined effectiveness of four types of components of behavioural interventions for cigarette smoking cessation: behavioural (e.g. counselling), motivational (e.g. focus on reasons to quit), delivery mode (e.g. phone), and provider (e.g. nurse).

Design

Systematic review and component network meta-analysis of randomized controlled trials identified from Cochrane reviews. Interventions included behavioural interventions for smoking cessation (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials), compared with another behavioural intervention or no support. Building on a 2021 review (CD013229), we conducted three analyses, investigating: comparative effectiveness of the components, whether models that allowed interactions between components gave different results to models assuming additivity, and predicted effect estimates for combined effects of components that had showed promise but where there were few trials.

Setting

Community and healthcare settings

Participants

Adults who smoke tobacco

Measurements

Smoking cessation at ≥6 months, preferring sustained, biochemically validated outcomes where available.

Findings

312 trials (250,563 participants) were included. 50 were at high risk of bias using Cochrane risk of bias tool, V1 (ROB1); excluding these studies did not change findings. Head-to-head comparisons of components suggested that support via text-message (SMS) compared with telephone (odds ratio (OR) 1.48, 95% credibility interval (CrI) 1.13 to 1.94) or print materials (OR 1.44, 95% CrI 1.14 to 1.83) was more effective, individual delivery was less effective than delivery as part of a group (OR 0.78, 95% CrI 0.64 to 0.95). There was no conclusive evidence of synergistic or antagonistic interactions when combining components that were commonly used together. Adding multiple components that are commonly used in behavioural counselling suggested clinically relevant and statistically conclusive evidence of benefit. Components with the largest effects that could be combined, but rarely have been, were estimated to increase the odds of quitting between two and threefold. For example, financial incentives delivered via SMS, with tailoring a focus on how to quit, had an estimated OR of 2.94 (95% CrI 1.91 to 4.52).

Conclusions

Among the components of behavioural support for smoking cessation, behavioural counselling and guaranteed financial incentives are associated with the greatest success. Incorporating additional components associated with effectiveness may further increase benefit, with delivery via text-message showing particular promise.