In Australia interprofessional education (IPE) and collaborative practice were recognised to assist with chronic lifestyle diseases [
1]. A year later the World Health Organisation (WHO) launched their framework for action on IPE and collaborative practice, recognising a global health workforce crisis and recommended chronic lifestyle diseases as one of the areas that would benefit from IPP [
2]. The framework was based on research evidence showing that IPP can improve access, appropriate use of resources, and health outcomes. The nature and weight of that evidence however was not spelt out [
3] and minimal research has been conducted since this time to support these claims.
There is concern that health professionals struggle to understand collaboration [
4]. In particular, if roles and boundaries change, then power, status and authority alter and professional socialisation is challenged [
4,
5]. In a systematic review of interprofessional health care teams, Micken ([
6], as reported in [
2]), assessed the outcomes of effective teamwork on organisational, team and individual benefits (including to client and team members). Findings revealed few consistent outcomes.
Client feedback on the value of IPP for the benefit of their health is vital. A recent editorial on the impact of interprofessional education on practice and patient outcomes recommended the inclusion of patient experiences in study designs to better align education and practice and to impact person-centred outcomes [
7‐
10]. The authors also noted substantiating evidence however, for a positive link between IPP and client outcomes, has been scant in the literature. Despite the impact on client outcomes being vital this is where evidence is weakest [
11], and studies that sought feedback on their experience recognise that evidence is limited [
12].
In a major study of mechanisms of teamwork (one of the key elements of IPP) in stroke care pathways, clients did not notice the teamwork that was meant to be evident between themselves and their team of practitioners [
12,
13]. The researchers hypothesized that these clients were more concerned with the care and treatment required by ‘the team’ than the processes of teamwork per se. The lack of evidence on the direct impact of teamwork on clients during IPP warrants further investigation.
IPP teamwork, physical activity and smoking cessation
An area of health intervention that could benefit from the joint practice element (patient consulting sessions held jointly with multiple practitioners) of IPP teamwork is smoking cessation. In particular, the emerging use of physical activity (PA) behaviour change in conjunction with smoking cessation efforts where the composite benefit addresses two compatible health issues (smoking cessation and PA) in one intervention.
Several community based programs have shown that PA behaviour change can influence the success of smokers attempt to quit with the added benefit of increased levels of PA (e.g., [
14,
15]). PA has shown to be an effective adjunct to smoking cessation interventions and can help diminish cigarette cravings [
16] and other withdrawal symptoms, such as insomnia [
17], weight gain [
18], mood disturbance [
19] and stress [
20]. Furthermore, increases in PA have been shown to improve behavior change self-efficacy [
21], and improved self-efficacy has been connected to increased levels of sustained abstinence in smoking relapse prevention programs [
22‐
24]. This suggests that the behavior change self-efficacy gained from increased PA may also empower smoking behavior change.
In a 2014 systematic review of randomized-control-trials for PA based smoking cessation programs, Usher, Taylor and Falkner [
15] provided evidence of the effectiveness of such programs. Of the 20 studies reviewed, four-showed evidence of smoking cessation lasting in the short term (3 months), and two showed longer-term effectiveness (6-12 months). In the same year, Taylor et al. [
25] reported a large-scale randomized control study that utilized phone and face-to-face counselling sessions to support behavior change regarding smoking behavior and increasing PA. The intervention results reflected the efficacy of this approach with almost a quarter of participants in the intervention arm achieving a quit attempt, while 10% achieved abstinence at 16 weeks and over a third achieved a 50% reduction in daily cigarettes smoked.
The current paper expands the knowledge of smoking cessation intervention programs that also utilise PA promotion, and introduces the IPP model of joint practice, this program is known as ActivePlus. ActivePlus combines the delivery of the Quit smoking cessation program with the services of exercise physiologists in a community health setting. Previous iterations of the ActivePlus program (unpublished pilot studies), revealed that success was attributed to the allied health specialists. Patient feedback however, revealed independent specialist consultations resulted in the client being the mode of communication between practitioners, and the smoking cessation support from Quitline was impersonal, repetitive and reliant on participant initiation in comparison to the ongoing personalised support for PA offered by the exercise physiologist. This feedback inspired the introduction of the IPP model of joint practice into the current ActivePlus program, where both practitioners are present in all consultations to create strong interactions between specialists and ensure complimentary rather than contradictory advice is provided. In this situation, clients openly interact with the practitioners and a team is formed that provides client-centered care, active listening and a shared client narrative, all of which are key elements of IPP [
26].
To address the lack of literature on clients’ experience and the direct impact of teamwork on clients when involved in IPP, the present study focuses on the interaction between clients and the practitioner team in the smoking cessation and PA context. Therefore, the aim of this paper is to explore the IPP aspect of the ActivePlus program gained from the experience of participants.