Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

Abstract

BackgroundGuided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework.MethodsThis pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention.Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended).Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended.ConclusionsGiven that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation.Trial registrationClinicalTrials.gov, NCT01309217 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0511-6) contains supplementary material, which is available to authorized users.

Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study

“…Barriers to patient adoption of the mHealth program were collected before and after active implementation by survey of the nurse staff. The question posed to nurses was, “Do you think any of the below reasons could be a barrier to introducing mobile messages to patients?” Responses were a checklist of potential barriers from a previously developed questionnaire [32] and those identified during the formative assessment [24].…”

“…Formative evaluation data on the strategies and intervention from purposive samples of nurses were collected by qualitative interview. Interview guides were developed using questions from previous evaluations [32]. We gathered acceptability data, asking the extent to which they agreed with the statement, “I would recommend other health care professionals to introduce these text messages as well.”…”

“…We measured daily engagement using the mobile message system database, with early disengagement of participants indicated by a response text message of “Stop.” In addition to our quantitative outcome, we conducted follow-up interviews with smokers. In parallel to the nurse interviews, guides were developed from previous evaluations [32]. Acceptability was ascertained by asking smokers about their level of agreement with the statement, “I would recommend these text messages for others” [34].…”

The next phase in professional services research: From implementation to sustainability

“…8 In addition several authors have used the term maintenance to refer to the stage at which sustainability is achieved. 9,10 It seems that researchers are using diverse terminology to refer to similar concepts, which can often lead to confusion and misinterpretation. This situation may be explained by a lack of consensus and heterogeneous data.…”

Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers

“…RE-AIM has been used previously to evaluate tobacco treatment programs in healthcare settings (13,14). However some elements of the framework, namely adoption, implementation, and maintenance, are often not reported (15,16), and most published studies report on measures collected as part of a research study rather than a pragmatic application in multiple, diverse clinical settings.…”