Quit & Stay Quit Monday
Implementation Plan
Contents
Q&SQM Implementation guidelines ....................................................................................................................................... 3
Suggested Q&SQM programmatic ideas ................................................................................................................................ 4
Full Evaluation Plan ................................................................................................................................................................. 5
Abridged Evaluation Plan ........................................................................................................................................................ 6
Evaluation Matrix .................................................................................................................................................................... 7
Baseline Participant Survey..................................................................................................................................................... 9
Baseline Participant Survey (short) ....................................................................................................................................... 11
Follow-up Participant Survey ................................................................................................................................................ 12
Follow-up Participant Survey (short) .................................................................................................................................... 14
Group Coordinator Baseline Survey...................................................................................................................................... 15
Group Coordinator Post-Intervention Survey ....................................................................................................................... 16
Program Implementation Checklist ...................................................................................................................................... 17
Updated: 4/17/2013
2
Q&SQM Implementation guidelines
These are key elements of Q&SQM that should be implemented into your current program.
1. Hand out bifold brochures to hospitals, doctors’ offices, local businesses, and organizations where smoking quit
groups are held.
a. Materials: QSQM bifold brochure
2. Print out and display Q&SQM posters and flyers in high-traffic areas (i.e. bulletin boards, building entryways,
etc.)
a. Materials: QSQM posters and poster templates
3. Create and disseminate announcements about Q&SQM and smoking groups on social media or in
emails/newsletters/local media etc.
a. Materials:
i. Announcement template for social media/email/newsletter
ii. Standard copy for local media announcement
4. Distribute the baseline evaluation survey for participants at the start of the first cessation group
a. Materials: Baseline survey for participants
5. Follow Q&SQM on Facebook (as well as other social media sites) and share the Quit tip each Monday
a. Materials: Link to Q&SQM Facebook, Twitter, Pinterest
6. Continue to engage group members by sending out weekly tips, group meeting reminders, links to resources,
announcements, and encouraging notes on Mondays
a. Materials:
i. Smoking cessation tips: Tips in visual format for social media, email and poster/print materials
ii. Reminders about group meetings/events: Meeting/event template
iii. Notes of encouragement to quit and stay quit: Standard copy to inset into email
iv. Links to other resources, including QSQM site/social media: Standard copy to insert into email
that lists our links
v. Announcements about Monday-related discounts/rewards for quitters: Monday
discount/reward coupon template
7. Distribute the post-intervention evaluation survey for participants at the start of the last cessation group (or
distribute when you do follow-up).
a. Materials: Post-intervention survey for participants
3
Suggested Q&SQM programmatic ideas
These are suggested elements to enhance the use of Q&SQM in your existing program.
1. Each Monday, encourage smoking cessation group participants to check their home/car/office for smoking
accessories and get rid of them.
Materials: Accessories tip for email/social media
2. On Mondays, encourage participants to review their cravings/triggers journals. If your program does not already
involve journaling, encourage participants to write down when they experienced cravings in the past week, what
triggered those cravings, whether the cravings resulted in smoking and/or what strategies they used to get
through the cravings. If they had no cravings/triggers for the week, they should note any thoughts they have on
how they were able to avoid cravings/triggers.
Materials: Trigger/craving journal template
3. On Mondays, encourage participants to review their reasons for quitting smoking. These reasons should be
listed out when they first decide to quit and kept visible in places that the participants associate with smoking
(i.e. kitchen, car, bedroom, etc.).
Materials: Reasons for quitting template (i.e. a card, a magnet, a poster, etc.)
4. Encourage participants to check their calendars each Monday to identify any appointments they have located at
or near any place that might not be smoke-free. They should then work on plans to either avoid those places, or
come up with strategies in advance for how they will negotiate the smoking environment so that it doesn’t
trigger them to smoke.
Materials:
i. Trigger sticker for calendar
ii. Strategy pocket card template
5. Encourage quitters to engage in stress reduction and/or meditation practices each Monday to mentally prepare
them for the week. Group leaders can provide stress reduction and meditation technique tip sheets to
participants. Group leaders can also reach out to local yoga studios, fitness facilities, or other local businesses to
get arrange discounts for Q&SQM group participants.
Materials:
i. Stress reduction tip sheet
ii. Flyer/coupon template for local business discounts
iii. QSQM window decal for participating businesses
6. Each Monday, encourage participants to check-in with their “Quit Buddy” about how the previous week went
and what they anticipate for the coming week. Quit Buddies can help each other talk through strategies to
avoid triggers and can congratulate each other on successes or encourage each other to get back on track after a
relapse.
Materials: Quit Buddy check-in tip
7. Mondays should be a day that participants reward themselves for a smokefree week. Encourage group
participants to take the money they would have normally spent on cigarettes and use it on something else they
want that they might not normally spend money on.
Materials: Labels for money jar for rewards
8. On Mondays, encourage participants who were able to remain smoke-free the previous week to send a message
to their support network (friends, family, etc.) to communicate their success and elicit encouragement
Materials:
i. Smoke-free badge or e-card for email and/or social media
4
Full Evaluation Plan
If your program does not perform a comprehensive evaluation of your smoking program, implement the Full Evaluation
Plan.
Step 1: Gather all the statistical and procedural information needed to answer the questions on the Group
Coordinator Baseline Survey to assess what your tobacco cessation group’s quit rates are before implementing
Q&SQM.
Step 2: To assess a baseline measurement, distribute the Baseline Participant Survey to all participants before
implementing Q&SQM. This survey will assess the relative individual factors that lead them to seek services from the
smoking cessation group.
Step 3: Gather all statistical and procedural information needed to answer the questions on the Group Coordinator
Post-Intervention Survey and fill out the Program Implementation Checklist to assess what methods of promotion the
group coordinators used and how the quit experiences of group members changed after implementing Q&SQM.
Step 4: When participants complete the smoking cessation program, distribute to them the Post-intervention
Participant Survey to help assess any changes in individual factors and whether changes may be associated with the
initiation of Q&SQM.
5
Abridged Evaluation Plan
If your program already performs a comprehensive evaluation of your smoking program, you may implement the
Abridged Evaluation Plan. You can distribute the survey questions separately, or add the questions to your existing
surveys.
Step 1: To assess a baseline measurement, distribute the Baseline Participant Survey to all participants before
implementing Q&SQM or attach the questions to your existing baseline survey. This survey will assess the relative
individual factors that lead them to seek services from the smoking cessation group.
Step 2: Gather all the statistical and procedural information needed to answer the questions on the Group
Coordinator Baseline Survey to assess what your tobacco cessation group’s quit rates are before implementing
Q&SQM.
Step 3: Gather all statistical and procedural information needed to answer the questions on the Group Coordinator
Post-Intervention Survey and fill out the Program Implementation Checklist to assess what methods of promotion the
group coordinators used and how the quit experiences of group members changed after implementing Q&SQM.
Step 4: When participants complete the smoking cessation program, distribute to them the Post-intervention
Participant Survey or add the questions to your existing evaluations. This information will help assess any changes in
individual factors and whether changes may be associated with the initiation of Q&SQM.
6
Evaluation Matrix
The Evaluation Matrix demonstrates how each evaluation question is related to the evaluation outcomes, and how each
evaluation outcome is measured.
Evaluation Question:
What questions about the
success of the campaign do you
want to answer?
Evaluation Outcome:
What goals do you hope to
achieve with this campaign?
Measurement Tools
How do we measure if we achieved our goals?
For how long are participants
quitting?
By the end of the program, ___%
of participants will have
maintained cessations for the full
time in the program
1. Participant surveys – “After your most
recent quit, how long did you go without
smoking?”
2. Group coordinator survey – “Upon
follow-up, what percentage of patients
who completed the program sustained
their quit?”
Upon follow-up, ___% of
participants who leave the
program will continue to
maintain their quit
How much time passes between
relapses and second quit
attempts?
By the end of the program, ___%
of relapses will have attempted a
second quit attempt within one
week.
Upon follow-up, ___% of
participants who relapsed after
leaving the program will have
made a second quit attempt
within one week.
3. Participant surveys – “If you started
smoking again, how long did it take you to
try to quit again?”
4. Group coordinator survey – “Upon
follow-up, what percentage of patients
who relapsed tried to quit again?”
Are participants more engaged in
the program after
implementation of Q&SQ
Mondays? (Do participants name
Monday as the day they reaffirm
their quit?)
By the end of the program, ___%
of cessation group participants
will name Monday as a day to
reaffirm their quit.
5. Participant surveys – “What strategies did
you use to quit?”
Are participants aware of the
Q&SQ Mondays campaign?
By the end of the first week of
implementation, ___% of
cessation group participants will
be able to identify the Q&SQ
Mondays campaign.
6. Participant post-Q&SQM survey – “Have
you heard of Quit & Stay Quit Monday?”
By the end of the program, 100%
of cessation group participants
will be able to identify the Q&SQ
Mondays campaign.
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How is the Q&SQ Mondays
campaign promoted?
By the end of one year, clinicians
will be able to identify successful
and unsuccessful promotional
strategies for the Q&SQ Monday
campaign.
7. Group coordinator survey – “What Quit &
Stay Quit Monday materials did you use?”
8. Group coordinator survey – “How did you
promote Quit & Stay Quit Monday to your
cessation group?
9. Participant post-Q&SQM survey – “If you
have heard of Q&SQM, how did you hear
about it?”
Do more quit attempts occur on
Mondays?
By the end of the program, ___%
of participants will report having
quit on a Monday.
10. Participant surveys – “Did you set a quit
day?” “What was the date you quit?”
Are participants who quit on
Mondays more likely to sustain
their smoking cessation?
By the end of the program, ___%
of participants who quit on
Mondays will have maintained
cessation for 6 months or more.
11. [Question 3 above: Participant survey –
“How long have you gone without
smoking?”]
Are certain participants
influenced more by Q&SQ
Mondays than others?
Demographic information:
Age, stage of change, language
spoken, sex
12. Participant surveys – “What is your age?”
“What is your sex?” “What is your primary
language?” “How ready are you to quit?”
13. Group coordinator survey – “What is the
age range of most of your group
members?” “What languages do your
participants speak?” “Where are most of
your group participants in their quit?”
Would participants recommend
Q&SQM to others trying to quit
smoking?
By the end of the program, 100%
of participants will report that
they would recommend Q&SQM.
14. Participant post-Q&SQM survey – “If
you’ve heard of Quit & Stay Quit Monday,
would you recommend it to someone who
is trying to quit smoking?”
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Baseline Participant Survey
1. How many cigarettes do you smoke per day?
_________________
2. How ready are you to quit smoking cigarettes?
a. Starting to think about quitting
b. Making plans to quit
c. Quit less than 6 months ago and avoiding relapse
d. Quit over 6 months ago and maintaining my quit
e. Prefer not to answer
3. What are your main reasons for wanting to quit smoking? (Select all that apply)
a. Because of a health problem I have
b. It is better for my health, generally
c. My doctor said I should quit
d. My family/friends want me to quit
e. Quitting smoking will save me money
f. Worried about the effect of second-hand smoke on friends/family
g. Other (please specify)
4. Did you set a quit day?
a. Yes
b. No
c. I don’t remember
5. What was the date you quit?
a. ___________________________
b. I don’t remember
c. I have not set a date to quit
6. When you last tried to quit, how long did you stay off cigarettes?
a. Less than a day
b. 1 to 7 days
c. More than 7 days but less than 30 days
d. More than 30 days but less than 6 months
e. More than 6 months but less than a year
f. More than a year
g. I have not quit smoking
h. Prefer not to answer
7. If you started smoking cigarettes again, how long did it take you to try to quit again?
a. Less than a day
b. 1 to 7 days
c. More than 7 days but less than 30 days
d. More than 30 days but less than 6 months
e. More than 6 months
f. I have not tried to quit again
g. I have not started smoking again
h. Prefer not to answer
8. What strategies did you use to quit? (Select all that apply)
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a. Oral substitutes (i.e. gum, toothpicks, cinnamon sticks, etc.)
b. Individual, face to face counseling
c. Nicotine replacement (nicotine gum, lozenges, patches, etc.)
d. Medication (Bupropion, Wellbutrin, Zyban, etc.)
e. Followed Quit & Stay Quit Monday’s weekly tips on social media
f. Made Monday the day recommitted to my quit each week
g. Used a support system of family and friends
h. Joined a smoking cessation group or class
i. Cold turkey
j. Other (please specify)_________________________________
k. Prefer not to answer
9. What is your age?
a. Under 18
b. 18-25
c. 26-35
d. 36-45
e. 46-55
f. 56 and older
g. Prefer not to answer
10. What is your sex?
a. Male
b. Female
c. Transgendered
d. Prefer not to answer
11. Create a 4-digit username using letters and numbers (i.e. 9932 or B475). Choose something that you can easily
remember. Record your username in your Quit & Stay Quit Monday Guide.
________________
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Baseline Participant Survey (short)
1. How many cigarettes do you smoke per day?
_________________
2. If you set a date to quit smoking, what was the date?
a. ___________________________
b. I don’t remember
c. I have not set a date to quit
2. When you last tried to quit, how long did you stay off cigarettes?
a. Less than a day
b. 1 to 7 days
c. More than 7 days but less than 30 days
d. More than 30 days but less than 6 months
e. More than 6 months but less than a year
f. More than a year
g. I have not quit smoking
h. Prefer not to answer
3. If you quit, but started smoking cigarettes again, how long did it take you to try to quit again?
a. Less than a day
b. 1 to 7 days
c. More than 7 days but less than 30 days
d. More than 30 days but less than 6 months
e. More than 6 months
f. I have not tried to quit again
g. I have not started smoking again
h. Prefer not to answer
4. What strategies did you use to quit? (Select all that apply)
a. Oral substitutes (i.e. gum, toothpicks, cinnamon sticks, etc.)
b. Individual, face to face counseling
c. Nicotine replacement (nicotine gum, lozenges, patches, etc.)
d. Medication (Bupropion, Wellbutrin, Zyban, etc.)
e. Followed Quit & Stay Quit Monday’s weekly tips on social media
f. Made Monday the day recommitted to my quit each week
g. Used a support system of family and friends
h. Joined a smoking cessation group or class
i. Cold turkey
j. Other (please specify)_________________________________
k. Prefer not to answer
5. Create a 4-digit username using letters and numbers (i.e. 9932 or B475). Choose something that you can easily
remember. Record your username in your Quit & Stay Quit Monday Guide.
________________
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Follow-up Participant Survey
1. What are your main reasons for wanting to quit smoking? (Select all that apply)
a. Because of a health problem I have
b. It is better for my health, generally
c. My doctor said I should quit
d. My family/friends want me to quit
e. Quitting smoking will save me money
f. Worried about the effect of second-hand smoke on friends/family
g. Other (please specify)
2. If you set a date to quit, what was your quit day?
a. ___________________________
b. I don’t remember
c. I have not set a date to quit
3. What strategies did you use to quit? (Select all that apply)
a. Oral substitutes (i.e. gum, toothpicks, cinnamon sticks, etc.)
b. Individual, face to face counseling
c. Nicotine replacement (nicotine gum, lozenges, patches, etc.)
d. Medication (Bupropion, Wellbutrin, Zyban, etc.)
e. Followed Quit & Stay Quit Monday’s weekly tips on social media
f. Made Monday the day recommitted to my quit each week
g. Used a support system of family and friends
h. Joined a smoking cessation group or class
i. Cold turkey
j. Other (please specify)_________________________________
k. Prefer not to answer
4. Are you smoking now?
a. Yes
b. No
5. If yes, how many cigarettes per day do you smoke?
________________
6. If no, how long has it been since your last cigarette?
a. Less than a day
b. 1 to 7 days
c. More than 7 days but less than 30 days
d. More than 30 days but less than 6 months
e. More than 6 months
f. Prefer not to answer
7. How many quit attempts have you made since the start of your cessation program?
a. 1
b. 2 - 4
c. 5 or more
8. How many quit attempts have you made in your lifetime?
a. 1
b. 2 – 5
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10.
11.
12.
13.
c. 6 – 9
d. 10 or more
If you have heard of Quit & Stay Quit Monday, how did you hear about it? (Select all that apply)
a. My smoking cessation group coordinator
b. Fellow members of my smoking cessation group
c. Posters or brochures
d. Facebook or Twitter
e. Quit & Stay Quit Monday website
f. I have not heard of Quit & Stay Quit Monday
g. Prefer not to answer
h. Other (please specify) ______________________________________________________
If you’ve heard of Quit & Stay Quit Monday, would you recommend it to someone who is trying to quit smoking?
a. Yes
b. No
c. I have not heard of Quit & Stay Quit Monday
d. Prefer not to answer
What is your age?
a. Under 18
b. 18-25
c. 26-35
d. 36-45
e. 46-55
f. 56 and older
g. Prefer not to answer
What is your sex?
a. Male
b. Female
c. Transgendered
d. Prefer not to answer
Write down your 4-digit username (i.e. 9932 or B475): ___________________________________________
13
Follow-up Participant Survey (short)
1. If you set a date to quit smoking, what was the date?
a. ___________________________
b. I don’t remember
c. I have not set a date to quit
2. Are you smoking now?
a. Yes
b. No
3. If yes, how many cigarettes per day do you smoke?
________________
4. If no, how long has it been since your last cigarette?
a. Less than a day
b. 1 to 7 days
c. More than 7 days but less than 30 days
d. More than 30 days but less than 6 months
e. More than 6 months
f. Prefer not to answer
5. How many quit attempts have you made since the start of your cessation program?
a. 1
b. 2 - 4
c. 5 or more
6. How many quit attempts have you made in your lifetime?
a. 1
b. 2 – 5
c. 6 – 9
d. 10 or more
7. What strategies did you use to quit? (Select all that apply)
a. Oral substitutes (i.e. gum, toothpicks, cinnamon sticks, etc.)
b. Individual, face to face counseling
c. Nicotine replacement (nicotine gum, lozenges, patches, etc.)
d. Medication (Bupropion, Wellbutrin, Zyban, etc.)
e. Followed Quit & Stay Quit Monday’s weekly tips on social media
f. Made Monday the day recommitted to my quit each week
g. Used a support system of family and friends
h. Joined a smoking cessation group or class
i. Cold turkey
j. Other (please specify)_________________________________
k. Prefer not to answer
8. If you’ve heard of Quit & Stay Quit Monday, would you recommend it to someone who is trying to quit smoking?
a. Yes
b. No
c. I have not heard of Quit & Stay Quit Monday
d. Prefer not to answer
9. Write down your 4-digit username (i.e. 9932 or B475): __________________________________
14
Group Coordinator Baseline Survey
1. What is your tobacco cessation program’s completion rate?
a. Before implementing Quit & Stay Quit Monday:
i. Number of participants who start the program:
ii. Number of participants who finish the program:
2. Upon follow-up, how many patients who finished the program are still tobacco-free?
3. Upon follow-up, how many patients who finished the program relapsed?
a. Upon follow-up, how many patients who relapsed tried to quit again?
4. Where are most of your group participants in their quit?
a. No intention to quit in next 6 months
b. Intend to quit in next 6 months
c. Intend to quit in next 30 days and has made plans to quit
d. Quit for less than 6 months
e. Sustained quit for more than 6 months
f. Quit, but started smoking again within 4 months
15
Group Coordinator Post-Intervention Survey
Complete the following questions along with the Program Implementation Checklist.
1. What is your tobacco cessation program’s completion rate?
a. After implementing Quit & Stay Quit Monday:
i. Number of participants who start the program:
ii. Number of participants who finish the program:
2. Upon follow-up, how many patients who finished the program are still tobacco-free?
3. Upon follow-up, how many patients who finished the program relapsed?
a. Upon follow-up, how many patients who relapsed tried to quit again?
4. Where are most of your group participants in their quit?
a. No intention to quit in next 6 months
b. Intend to quit in next 6 months
c. Intend to quit in next 30 days and has made plans to quit
d. Quit for less than 6 months
e. Sustained quit for more than 6 months
16
Program Implementation Checklist
Indicate which aspects of Quit & Stay Quit Monday were used for your cessation group.
Check if
Q&SQM Activity
completed
Distributed the QSQM bifold brochure to doctors’ offices, hospitals,
group meeting sites, and participants
Displayed QSQM posters
Disseminated announcements about Q&SQM and smoking groups on
social media or in emails/newsletters
Collected baseline data using the Baseline Participant Survey
Collected baseline data using the Group Coordinator Baseline Survey
Linked participants to Q&SQM social media (Facebook, Twitter,
Pinterest)
Engaged group members by sending out weekly tips, group meeting
reminders, links to resources, announcements, and encouraging notes
on Mondays
Collected follow-up data using the Post-Intervention Participant Survey
Collected post-intervention data using the Group Coordinator PostIntervention Survey
Each Monday, encouraged smoking cessation group participants to
check their home/car/office for smoking accessories and get rid of them
On Mondays, encouraged participants to review their cravings/triggers
journals
On Mondays, encouraged participants to review their reasons for
quitting smoking
Encouraged participants to check their calendars each Monday to
identify any appointments they have located at or near any place that
might not be smoke-free
Encouraged quitters to engage in stress reduction and/or meditation
practices each Monday to mentally prepare them for the week
Reached out to local yoga studios, fitness facilities, or other local
businesses to get arrange discounts for Q&SQM group participants
17
Note any alterations to
implementation
Each Monday, encouraged participants to check-in with their “Quit
Buddy” about how the previous week went and what they anticipated
for the coming week
Encouraged group participants to take the money they would have
normally spent on cigarettes and use it on something else they want that
they might not normally spend money on
On Mondays, encouraged participants who were able to remain smokefree the previous week to send a message to their support network
(friends, family, coworkers, etc.)
18