Breaking a cigarette

This mixed-methods evaluation explored the feasibility and acceptability of a hybrid smoking cessation service (one which offers remote, face-to-face and blended provision).




Smoking remains the largest avoidable cause of premature death and disability in the UK. There are approximately 60,000 smokers within North Yorkshire, with higher rates in areas of greater deprivation, and above national average rates of smoking during pregnancy.

The Covid-19 pandemic resulted in many people being unable to access healthcare services, including stop smoking services. The North Yorkshire Living Well Smokefree (LWSF) service responded to this by developing a remote stop smoking service, where support sessions were delivered over the phone or online instead of face-to-face.

As Covid-19 restrictions begin to relax, LWSF have been interested in using the learning and benefits (e.g., increased accessibility for rural communities) they have gained in supporting people remotely, and have developed a ‘hybrid’ service model, where they want to deliver support for people trying to stop smoking both face-to-face and remotely.

Our evaluation project looked to see if this ‘hybrid’ approach is working, if it should be continued to be used, and how it may be improved. We were interested to see if this approach resulted in a higher number of people quitting smoking, if it helped different groups of people access stop smoking services, and if it was a cost-effective way to deliver stop smoking services.

Methods and results

The evaluation employed a mixed methods approach using interviews and focus groups to collect primary qualitative data which explored service staff and service users’ perspectives and experiences of the hybrid LWSF service, and used existing quantitative data to explore service monitoring and outcome measures.

The findings of the evaluation will provide North Yorkshire County Council with evidence which will help them understand the acceptability and feasibility of the hybrid LWSF service, and which will help them shape current and future service delivery.

The findings will generate policy and practice recommendations for the delivery of smoking cessation services. Locally the findings will be used to shape and inform how the smoking cessation services across North Yorkshire County Council could be delivered.

Beyond the local service landscape, smoking cessation services more generally will benefit from the translational knowledge produced around if hybrid and blended approaches are acceptable delivery models to service users and practitioners, are equitable and provide value for money.


The evaluation was carried out by members of the NIHR Public Health Intervention Responsive Studies Team (PHIRST) Fusion team, a group of expert academics who work with local authorities to co-produce research on the public health impacts of initiatives.

For this evaluation the team included:

PHIRST Fusion Research Team
Professor Elizabeth Goyder – University of Sheffield
Dr Duncan Gillespie – University of Sheffield
Dr Nicholas Woodrow – University of Sheffield
Dr Andrew Passey – Newcastle University
Dr Ryc Aquino – Newcastle University

Local Authority/Partner(s)
Scott Chapman – North Yorkshire County Council
Mark O’Brien – North Yorkshire County Council

Further information and findings

Details of the project and results are available below and on the NIHR PHIRST website.

Download: Final Evaluation Report (PDF)
Download: Final Evaluation – Summary of Key Findings Presentation (.pptx)

Woodrow N, Gillespie D, Kitchin L et al. (2024) Reintroducing face-to-face support alongside remote support to form a hybrid stop smoking service in England: a formative mixed methods evaluation BMC Public Health DOI:

SCHARR Communicable Research podcast: In this episode, ‘Quitting Cigarettes: Making cessation support inclusive and equitable’, Andy Tattersall is joined by Dr Duncan Gillespie and Dr Nick Woodrow from the University of Sheffield alongside Mark O’Brien and Scott Chapman from North Yorkshire Council to discuss the Living Well Smokefree service evaluation. Listen on Spotify |  Apple Podcasts  |  University of Sheffield Player


This project was funded by the National Institute for Health Research (NIHR) [Public Health Research Programme (NIHR131566/PHIRST)]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.