Dr Omara Dogar
Dr Omara Dogar is a leading researcher in behavioural tobacco treatment. She tells us about her transformative research as part of the Sparks programme Administrative Fairness in Healthcare, examining how healthcare practitioners talk to and work with people undergoing behavioural tobacco treatment, and her aim to leave no one behind when it comes to stopping smoking.
What is behavioural tobacco treatment?
Behavioural tobacco treatment is all about supporting people who smoke to quit by modifying their health beliefs and attitudes.
Everyone has different needs, so there are different types of behavioural support treatments and different techniques you can use to help somebody think about why they're smoking, why they would want to give up, and then support them through that process.
Tell us more about your research background which led you to this project.
It all started when I did my PhD, at York, about 12 years ago. I was working on a trial in Pakistan. It was a ‘cluster randomised controlled trial’ across 33 lung health clinics .
We noticed differences in smoking quit success rates between clinics, ranging from seven to 70%, despite using the same intervention. There was no difference in the content that the practitioners at each clinic were delivering. It was how they were delivering that content, which made the whole difference.
What were the practitioners doing differently that was working?
They were seeing the individual as a whole person. The practitioners who built rapport, listened actively, and personalised interventions to the individual’s circumstances had at least twice as many patients quit smoking.
Could you tell us a little bit more about how you carry out your research. What kinds of methodologies do you use?
We often assume that practitioners have the necessary ‘soft skills’ for providing behavioural support, but this isn’t always true. There's still very little evidence on what actually works and which of those approaches are useful.
For the Sparks project, we’re using a mixed-methods approach, focusing on people who smoke in Leeds. Working with Leeds City Council and the Leeds Stop Smoking Services, we want to understand more about the experiences of people who smoke as well as the practitioner’s perspective on how their interactions with people who smoke can be improved.
What stage is the project at now?
We’re about halfway through the project. The first year focused on developing networks, designing the research, and identifying aligned services.
We engaged with stop smoking services across the country, and the Leeds Stop Smoking Services were particularly interested in understanding how they can maximise engagement to improve treatment outcomes. They have been a key stakeholder in this project, helping shape the research and data collection. The project officially started last month, and with researchers on board, it’s been brilliant.
Has anything surprised you about it so far?
The biggest surprise has been the lack of literature on these approaches which focus on high quality interactions. My PhD focused on research and theory, but I found little practical information about the communications skills needed to deliver this kind of treatment.
This led me to realise that this research needs to be developed from practice, which for a researcher is like working backwards! It really changed my perspective on designing this kind of research.
How will your research help reduce health inequalities?
Behavioural tobacco treatments often benefit more informed and economically advantaged groups. In the UK, about one in four people from advantaged groups quit smoking, compared to only one in 10 from disadvantaged groups.
This research specifically targets those less likely to engage with treatment. By focusing on the interactions between people who smoke and practitioners, we aim to improve treatment engagement that would potentially impact quit outcomes, we aim to reduce inequalities.
What do you think is the most challenging aspect of this research?
Figuring out how and where to apply for different types of ethics approval is complex and can take a long time. We’re using various qualitative methods to understand the problem from many perspectives, and it involves observations and interviews with patients who smoke; people who smoke in the community; and NHS practitioners.
However, the biggest challenge across all of my research is also my biggest motivation: how to design research that makes a tangible difference to people’s lives. Embedding your research into the systems that need to change takes time, and patience.
How do you see this project developing in the future?
There’s a lot happening in Yorkshire in smoking cessation services, and the region is developing a centre of excellence for addictions, to which I hope my research can add some value.
My research focuses on training the workforce on how to have effective conversations and build relationships with people who smoke, and it has real potential to drive timely action. Using compassionate, non-judgemental communication could help foster strong relationships between people who smoke and practitioners, laying the foundation for a collaborative and trusted patient treatment journey, particularly benefiting those more susceptible to disengage from treatment during its course.
The previous Conservative government recently passed a law increasing the legal age to buy cigarettes each year, so people born in or after 2009 will never be able to buy them. Do you think this will help the people your research aims to reach?
The change in law will definitely benefit future generations from starting to smoke. But this needs to come alongside support for those who are already hooked on smoking. We need to make sure that these groups aren’t left behind.
The Administrative Fairness Lab at York, who are connected to this Sparks programme, has a very interdisciplinary approach. What does this mean for your research?
This project has helped me find my footing in the interdisciplinary space. When I spoke to Dr Jed Meers (co-lead of Administrative Fairness in Healthcare and a lecturer at York Law School) and the team about this Sparks project, Administrative Fairness in Healthcare, we compared notes and my research just seemed to fit in seamlessly. This was because our overall goal was the same: to positively impact patient outcomes by improving patient engagement.
What message do you have for future applicants to the Sparks programme? How has it benefited you?
This research hasn’t been done before and it therefore doesn’t have the strong evidence base and preliminary work which funders are looking for. Sparks gave me the time, space and budget to be able to do some preliminary research in this area and develop that proof of concept to take it forward in the future. It’s going to be hugely beneficial for my research in the future - it’s a springboard!