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Regan C, Dray J, Fehily C, Campbell E, Bartlem K, Orr M, Govindasamy S, Bowman J. Co-development of implementation strategies to assist staff of a mental health community managed organisation provide preventive care for health behaviours. Health Promot J Austr 2024; 35:813-823. [PMID: 37821103 DOI: 10.1002/hpja.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
ISSUE ADDRESSED People with a mental health condition are at risk of developing chronic physical disease due to smoking tobacco, inadequate nutrition, high alcohol consumption, low physical activity and poor sleep (SNAPS). Community managed organisations (CMOs) represent an opportune setting to support mental health consumers to improve their health behaviours through providing preventive care. Reporting of methods used to co-develop implementation strategies to assist CMO staff to deliver preventive care for SNAPS are scarce yet warranted. OBJECTIVES This study aims to: (1) describe a co-development workshop involving CMO staff and researchers to identify preferred implementation support strategies to help staff routinely provide preventive care; (2) describe the strategies that emerged from the workshop; and (3) report staff ratings of the workshop on four co-development principles. METHODS A three-hour co-development workshop was conducted on two occasions with staff of one CMO in New South Wales, Australia. Twenty staff participated in the workshops. RESULTS Participants generated and ranked a total of seven discrete implementation strategies within five categories (training, point of care prompts, guidelines, continuous quality improvement and consumer activation). Training for staff to have difficult conversations about behaviour change was ranked highest in both workshops. Participants rated the workshops positively across four co-development principles. CONCLUSIONS The co-development workshop enabled implementation strategies to be developed within the context in which they were to be delivered and tested, potentially increasing their feasibility, acceptability, appropriateness and impact. SO WHAT?: Implementation strategies selected from the workshops will inform a pilot implementation support trial to assist CMO staff to provide preventive care to people with mental health conditions.
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Affiliation(s)
- Casey Regan
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Ultimo, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia Dray
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Caitlin Fehily
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Ultimo, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Bartlem
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Ultimo, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mark Orr
- Flourish Australia, Sydney Olympic Park, New South Wales, Australia
| | | | - Jenny Bowman
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Ultimo, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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2
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Thomas AG, Chelala L, King AC, Chung JH. Impact on patient attitudes towards lung cancer screening and smoking cessation with radiology consultation: Pilot survey project. Curr Probl Diagn Radiol 2024; 53:377-383. [PMID: 38267344 DOI: 10.1067/j.cpradiol.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/01/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE We developed a novel patient-radiologist consultation for patients scheduled for lung cancer screening (LCS). We hypothesized that this intervention would improve patient attitudes towards LCS adherence and smoking cessation. METHODS This quality improvement project enrolled 38 LCS patients (a majority were African American) and included 20 current and 18 former smokers. The intervention, a 5-10 min consultation with a radiologist who provided preliminary interpretation of pertinent imaging findings in conjunction with smoking cessation counseling, took place in the radiology reading room immediately after the low dose computed tomography (LDCT) patient scan. Pre- and post-intervention surveys assessed patient attitudes towards LCS and smoking cessation. RESULTS All recruited patients consented to participate in this project. Regarding viewing their LCS imaging, 86.8% (33/38) expressed general interest initially, with 100.0% (38/38) being more interested afterwards. On LCS logistics, 71.1% (27/38) reported prior knowledge at baseline, while 89.5% (34/38) reported being more informed following the intervention. Among current smokers, 90.0% (18/20) were already motivated towards quitting smoking at baseline, with 100.0% (20/20) exiting the intervention being more interested in doing so. Regarding smoking cessation resources, 95.0% (19/20) were interested in accessing such resources at baseline, and 90.0% (18/20, 2 were same/neutral) were more interested afterwards. CONCLUSIONS Patients' attitudes towards LCS and self-reported interest in quitting smoking were directionally higher after the consultation than at baseline. Incorporating LCS consultations with radiologists as part of patient-centered care provides a resource to educate patients on their own LCS imaging findings while promoting LCS adherence and smoking cessation.
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Affiliation(s)
- Alex G Thomas
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Lydia Chelala
- Department of Diagnostic Radiology, University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - Andrea C King
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue (MC-3077), Chicago, IL 60637, USA
| | - Jonathan H Chung
- Department of Diagnostic Radiology, University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637, USA; Department of Diagnostic Radiology, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA.
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3
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Schuler BR, Collins BN, Scheuermann TS, Baishya M, Kilby L, Lepore SJ. Translating pediatric primary care best practice guidelines for addressing tobacco in the WIC system. Transl Behav Med 2023; 13:57-63. [PMID: 36434752 PMCID: PMC9972351 DOI: 10.1093/tbm/ibac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development-nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre-post outcomes were assessed using bivariate statistics and multiple regression models. Controlling for baseline AAR-related practices and other covariates, nutrition managers were more likely to engage in post-training AAR practices than nutrition assistants. Sociodemographics and smoking status were not related to post-training AAR. Lower perceived barriers and higher reported frequency of tobacco intervention practices at baseline were associated with higher engagement in post-test AAR practices. WIC-system interventions aimed at reducing child TSE and maternal tobacco smoking may be more effective if nutrition management-level staff are involved in assessment and by addressing barriers related to TSE among nutrition assistants. Findings suggest that WIC in-clinic training may help to increase self-efficacy for staff engagement in brief screening, intervention, and referral practices.
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Affiliation(s)
- Brittany R Schuler
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Taneisha S Scheuermann
- Department of Population Health, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mona Baishya
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Linda Kilby
- N.O.R.T.H., Inc—Philadelphia WIC Program, Philadelphia, PA, USA
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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Implementing Brief Tobacco Cessation Interventions in Community Pharmacies: An Application of Rogers’ Diffusion of Innovations Theory. PHARMACY 2022; 10:pharmacy10030056. [PMID: 35736771 PMCID: PMC9230644 DOI: 10.3390/pharmacy10030056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
Pharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists’ perceptions of factors associated with the implementation of “Ask-Advise-Refer”, a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers’ Diffusion of Innovations Theory, assessed pharmacists’ perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.
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Boni FG, da Rosa YL, Leite RM, Lopes FM, Echer IC. Efeitos de uma intervenção educativa com profissionais de enfermagem sobre abordagens ao paciente tabagista: estudo quase-experimental. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0569pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar os efeitos de uma intervenção educativa sobre cessação do tabagismo direcionada à equipe de enfermagem. Método: estudo quase-experimental com 37 profissionais de enfermagem de um hospital brasileiro de maio/2019 a dezembro/2020. A intervenção consistiu em capacitar profissionais de enfermagem sobre abordagens aos pacientes tabagistas, dividida em duas etapas, a primeira, online, pré-requisito para a presencial/videoconferência. O efeito da intervenção foi avaliado por meio do pré- e pós-teste preenchido pelos participantes. Também foram analisados registros em prontuários de pacientes fumantes. Para análise, utilizou-se o Teste do Qui-Quadrado de McNemar. Resultados: houve aumento da frequência das ações visando à cessação tabágica após a intervenção. Diferenças significativas foram encontradas em orientações relacionadas à divulgação aos familiares da decisão de parar de fumar e necessidade de apoio, incentivo à abstinência após alta hospitalar e informações sobre estratégias para cessação do tabaco e recaídas. Conclusão: a intervenção educativa se mostrou inovadora e com grande capacidade de difusão do conhecimento. O pós-teste evidenciou efeito positivo na frequência das ações visando à cessação tabágica implementadas pela equipe de enfermagem.
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Le K, Chen TA, Martinez Leal I, Correa-Fernández V, Obasi EM, Kyburz B, Williams T, Casey K, Taing M, O’Connor DP, Reitzel LR. Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10485. [PMID: 34639785 PMCID: PMC8507614 DOI: 10.3390/ijerph181910485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
Although tobacco use is the leading preventable cause of death and is elevated among patients with substance use disorders, many substance use treatment centers (SUTCs) do not offer tobacco use interventions (i.e., screening and treatment). This study examined a key outcome of the implementation of a tobacco-free workplace program that provided education and specialized training to employees; namely, changes in clinician provision of the five As (Asking about tobacco use; Advising to quit; Assessing willingness to quit; Assisting with quitting; Arranging follow-up) from before to after the larger program implementation. The five As are a brief tobacco screening and treatment protocol that was taught as part of the program and that formed the basis for further intervention (e.g., provision of nicotine replacement therapies, Motivational Interviewing to enhance desire and willingness to make a quit attempt). Moreover, we also examined organizational moderators that may have impacted changes in the delivery of the five As over time among clinicians from 15 participating SUTCs. The number of the centers' total and unique annual patient visits; full-time employees; and organizational readiness for implementing change were assessed as potential moderators of change in clinicians' behaviors over time. Clinicians completed pre- and post-program implementation surveys assessing their provision of the five As. Results demonstrated significant increases in Asking (p = 0.0036), Advising (p = 0.0176), Assisting (p < 0.0001), and Arranging (p < 0.0001). SUTCs with higher Change Efficacy (p = 0.025) and lower Resource Availability (p = 0.019) had greater increases in Asking. SUTCs with lower Resource Availability had greater increases in Assessing (p = 0.010). These results help guide tobacco control program implementation to increase the provision of tobacco use interventions (i.e., the five As) to SUTC patients and elucidate Change Efficacy and Resource Availability as organizational factors promoting this clinician behavior change.
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Affiliation(s)
- Kathy Le
- Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Daniel P. O’Connor
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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7
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When primary care providers and smokers meet: a systematic review and metasynthesis. NPJ Prim Care Respir Med 2021; 31:31. [PMID: 34075057 PMCID: PMC8169673 DOI: 10.1038/s41533-021-00245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.
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Nitturi V, Chen TA, Kyburz B, Martinez Leal I, Correa-Fernandez V, O'Connor DP, Williams T, Garey L, Stacey T, Wilson WT, Lam C, Reitzel LR. Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician's Delivery of Smoking Interventions within Behavioral Health Treatment Clinics. Nicotine Tob Res 2021; 23:310-319. [PMID: 32832980 PMCID: PMC7822101 DOI: 10.1093/ntr/ntaa163] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/17/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Smoking is elevated amongst individuals with behavioral health disorders, but not commonly addressed. Taking Texas Tobacco Free is an evidence-based, tobacco-free workplace program that addresses this, in-part, by providing clinician training to treat tobacco use in local mental health authorities (LMHAs). This study examined organizational moderators of change in intervention delivery from pre- to post-program implementation. METHODS LMHA leaders completed the Organizational Readiness for Implementing Change (ORIC) and provided organization demographics pre-implementation. Clinicians (N = 1237) were anonymously surveyed about their consistent use of the 5As (Asking about smoking; Advising clientele to quit; Assessing willingness to quit; Assisting them to quit; Arranging follow-up) pre- and post-program implementation. Adjusted generalized linear mixed models were used for analyses (responses nested within LMHAs), with interaction terms used to assess moderation effects. RESULTS Clinician delivery of 5As increased pre- to post-implementation (p < .001). LMHAs with fewer employees (ref = ≤300) demonstrated greater increases in Asking, Assessing, and Assisting over time. LMHAs with fewer patients (ref = ≤10 000) evinced greater changes in Asking over time. Less initial ORIC Change Efficacy, Change Commitment, and Task Knowledge were each associated with greater pre- to post-implementation changes in Asking. Less initial Task Knowledge was associated with greater increases in Advising, Assessing, and Assisting. Finally, less initial Resource Availability was associated with greater increases in Assisting (all moderation term ps < .025). CONCLUSION The smallest and least ready LMHAs showed the largest gains in tobacco cessation intervention delivery; thus, low initial readiness was not a barrier for program implementation, particularly when efficacy-building training and resources are provided. IMPLICATIONS This study examined organizational moderators of increases in tobacco cessation treatment delivery over time following the implementation of a comprehensive tobacco-free workplace program within 20 of 39 LMHAs across Texas (hundreds of clinics; servicing >50% of the state) from 2013 to 2018. Overall, LMHAs with fewer employees and patients, and that demonstrated the least initial readiness for change, evinced greater gains in intervention delivery. Findings add to dissemination and implementation science by supporting that low initial readiness was not a barrier for this aspect of tobacco-free workplace program implementation when resources and clinician training sessions were provided.
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Affiliation(s)
- Vijay Nitturi
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX.,HEALTH Research Institute, University of Houston, Houston, TX
| | - Tzu-An Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX.,HEALTH Research Institute, University of Houston, Houston, TX
| | | | - Isabel Martinez Leal
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Virmarie Correa-Fernandez
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX.,HEALTH Research Institute, University of Houston, Houston, TX
| | - Daniel P O'Connor
- HEALTH Research Institute, University of Houston, Houston, TX.,Department of Health and Human Performance, University of Houston, Houston, TX
| | | | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX
| | | | | | - Cho Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX.,HEALTH Research Institute, University of Houston, Houston, TX
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Taing M, Kyburz B, Leal IM, Le K, Chen TA, Correa-Fernandez V, Williams T, O’Connor DP, Obasi EM, Casey K, Koshy L, Reitzel LR. Clinician Training in the Adaptation of a Comprehensive Tobacco-Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6154. [PMID: 32854185 PMCID: PMC7503354 DOI: 10.3390/ijerph17176154] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022]
Abstract
Tobacco use is exceedingly high among those who are homeless or at risk of homelessness but not commonly addressed by clinicians. Taking Texas Tobacco Free (TTTF) is a tobacco control program that addresses known clinician barriers to intervention (e.g., low training receipt, limited resources). Here, we examine the process and outcomes of TTTF's adaptation within four agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N = 68) to assess changes in training receipt, knowledge, and intervention behaviors, relative to program goals. Results indicated significant gains in clinicians' receipt of training in 9 (of 9) target areas (p's ≤ 0.0042) and a 53% knowledge gain (p < 0.0001). From pre- to post-implementation, there were mean increases in the use of the 5As (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen in assisting residents/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (p's ≤ 0.0491). All program goals, except gains related to advising smokers to quit and the use of specific interventions (behavioral counseling), were met. Overall, TTTF improved clinicians' capacity to address tobacco use among homeless and vulnerably housed individuals and can serve as a model for tobacco control efforts in similar agencies.
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Affiliation(s)
- Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Bryce Kyburz
- Integral Care, Austin, TX, USA; (B.K.); (T.W.); (K.C.)
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Kathy Le
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
- Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Tzu-An Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Virmarie Correa-Fernandez
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | | | - Daniel P. O’Connor
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | | | - Litty Koshy
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
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Aleshire ME, Fallin-Bennett A, Bucher A, Hatcher J. LGBT friendly healthcare providers' tobacco treatment practices and recommendations. Perspect Psychiatr Care 2019; 55:546-553. [PMID: 31093993 DOI: 10.1111/ppc.12395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study aimed to describe lesbian, gay, bisexual, and transgender (LGBT) friendly providers' (1) smoking cessation recommendations to LGBT patients and (2) tobacco treatment practices for transgender patients. DESIGN AND METHODS In-depth, semistructured phone interviews were conducted with 13 healthcare providers. FINDINGS Four overarching themes emerged: (1) providing tobacco treatment services for LGBT patients; (2) barriers to LGBT smoking cessation; (3) prescribing practices for transgender individuals taking estrogen hormone therapy; (4) provider community outreach to promote LGBT smoking cessation. PRACTICE IMPLICATIONS Holistic tobacco treatment services are needed to address LGBT-specific barriers to tobacco cessation, such as stress, identity-related factors, and inadequate healthcare access.
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Affiliation(s)
- Mollie E Aleshire
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina
| | | | - Amanda Bucher
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Jennifer Hatcher
- College of Public Health, University of Arizona-Phoenix, Phoenix, Arizona
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