Barriers to introduction of smoke-free workplaces in Central Europe: example of the Czech Republic

Implementation fidelity of a smoke-free workplace intervention in a private medical company: A mixed-methods process evaluation

INTRODUCTION

Smoke-free workplaces are considered an important part of tobacco control strategies. The purpose of this study was to evaluate implementation fidelity and explore the significance of social and contextual factors for the implementation of a strict smoke-free workplace intervention in a large Danish medical company.

METHODS

The UK Medical Research Council's guidance for process evaluation was used as a framework. Data were collected from approximately six months before the implementation until ten months after (2019-2020). A mixed method study design was used (a survey of 398 employees, a focus group of four employees and field visits on two days). Data were analyzed separately and later integrated through triangulation. We used the Fisher's exact test in the analysis of the questionnaire.

RESULTS

We assessed the implementation fidelity through four key factors: reach, dose and delivery, mechanisms of change, and context for the intervention components. Despite compliance issues, the policy component had high implementation fidelity. However, the implementation fidelity of the smoking cessation support component was low. We identified three social mechanisms influencing the employees' responsiveness towards the policy: expectation, the social aspect of the smoking facilities, and management leadership. COVID-19 was identified as the main contextual factor affecting the implementation.

CONCLUSIONS

Although not all elements of the intervention components were implemented as planned, the strict smoke-free workplace intervention is considered implemented. Further strategies can be initiated to raise implementation fidelity through better communication concerning the cessation support component, compliance, and enforcement of the policy.

Implementing a Nicotine-Free Policy in the United States Military

In December 2019, the command of a US Army Advanced Individual Training battalion on Fort Eustis, Virginia, was briefed on the results of tobacco and nicotine use surveys distributed to trainee soldiers and subsequently decided to ban tobacco and nicotine products in this population. The policy implementation process was thoroughly planned in a joint effort between battalion leadership and the installation military health facility. Data were collected throughout the process that evaluated nicotine product use among trainee soldiers, instructors, and leaders. Preferences on assistance with quitting and views on policy implementation processes also were collected. Comprehensive and multimodal resources and therapy to assist with treatment of dependence of tobacco and nicotine were offered. Although more data are needed on outcomes of this type of intervention, addressing tobacco and nicotine use in the military is long overdue, and our intervention offers a reproducible model to do so. It incorporates education, behavioral resources, and medication therapy with the aim to improve long-term quit rates and to improve the health of soldiers throughout and after their careers.