Management and Point-of-Care for Tobacco Dependence (PROMPT): a feasibility mixed methods community-based participatory action research project in Ottawa, Canada

Abstract

ObjectiveTo determine the feasibility of a Community-Based Participatory Tobacco Dependence Strategy (PROMPT) in the inner city population of Ottawa (Canada).DesignA feasibility mixed methods prospective cohort study following principles of community-based participatory action research.InterventionRecruited 80 people whouse drugs, followed them for 6 months while providing access to counselling, nicotine replacement therapy and peer-support in a community setting.SettingCommunity research office in downtown Ottawa, adjacent to low-income housing, shelter services and street-based drug consumption.Primary outcomeRetention rate at 6-month follow-up.Secondary outcomeBiochemically validated 7-day point prevalence smoking abstinence at 26 weeks, self-reported abstinence in the past 7 days with exhaled carbon monoxide ≤10 ppm.ResultsThe average age of participants was 43.8 years. The 6-month follow-up rate was 42.5%. The mean number of smoking years reported was 27.3 years. The participants were 70% male, 33.7% reported less than a high-school education, 21% identified as indigenous and 43.8% reported an income between US$1000 and US$1999 per month. The baseline mean daily cigarette use was 20.5 and 9.3 cigarettes at study end, with mean reduction of 11.2 cigarettes at 6 months (P=0.0001). There was a considerable reduction in self-reported illicit substance use (18.8%), including a reduction in the opioids heroin (6.3%), fentanyl (2.6%) and Oxycontin (3.8%). The study findings also reveal psycho-socioeconomic benefits such as improved health, return to work and greater community engagement.ConclusionsThe PROMPT project describes socioeconomic variables associated with tobacco and polysubstance use. A programme focused on tobacco dependence, easily accessible in the community and led by community peers with lived experience is feasible to implement and has the potential to support positive life changes. PROMPT’s patient engagement model is an effective harm-reduction strategy for the growing opioid use crisis and can improve the health outcomes of marginalised at-risk populations worldwide.

Provision of peer support at the intersection of homelessness and problem substance use services: a systematic ‘state of the art’ review

“…There were two other papers looking specifically at IPS -a qualitative study looking into the experiences of peer providers and recipients and their opinion of what makes IPS effective in homelessness recovery [34]; and a mixed methods Qsort study investigating the opinions of experts on what makes peer support effective with people who are homeless [35]. The remaining studies included: a quantitative pilot intervention of peer-led support for homeless youth [79]; a feasibility study of involving vendors of The Big Issue (a magazine sold by individuals who are homeless or at risk of homelessness that provides them with opportunities to earn an income) to become peer educators for people who are homeless to reduce drug related harms [55]; a study protocol for peer-led intervention for people who are experiencing homelessness and problem substance use [81]; a report from an independent evaluation of the Homeless Health Peer Advocacy Service programme on the impact on client's health, cost, and impact on the peers themselves [27]; a commentary on the need for more safe/supervised consumption sites and other overdose prevention interventions across a range of housing sites to minimise overdose risk [83]; a longitudinal evaluation of a Housing First peer support model [36]; an evaluation of the effects of peer delivered permanent supportive housing on health and mental health of an ethnically diverse population [51]; an evaluation of a group intensive peer support model of case management in a supported housing programme for homeless veterans [67], and four studies relating to smoking cessation peer interventions in poly-substance using individuals experiencing homelessness ( [47,48,54,80]).…”

Assessing community (peer) researcher’s experiences with conducting spirometry and being engaged in the ‘Participatory Research in Ottawa: Management and Point-of-care for Tobacco-dependence’ (PROMPT) project

“…PROMPT project outcomes unexpectedly impressed the community researchers, as participants not only reduced and/or quit tobacco smoking, but also other illicit substances such as fentanyl and oxycontin. Furthermore, community researchers were pleasantly surprised to observe that many of the PROMPT participants made additional improvements in other areas of their life; such as making the decision to return to school or work, eating healthier, and engaging in community-based work [ 12 ]. More specifically, the feasibility study demonstrated that of the 80 participants recruited in this study, 79% reported reducing their tobacco intake, 9% reported quitting tobacco use, 18.8% reported reducing poly-substance use, and 30% improved their general socio-economic status gradually helping them to improve their health and quality of life [ 12 ].…”

“…Moreover, patient engagement can improve patients’ knowledge and experience, use of health services, health behaviour, and health status [ 29 ]. The PROMPT project demonstrated that health behavior and health status of community researchers and the majority of the project participants did improve [ 12 ]. However, involving patients can be challenging if one considers multiple goals of care for an individual [ 30 ].…”

“…Importantly, it is well known that the prevalence of tobacco smoking is significantly higher in PWUD and in the homeless or at-risk for homelessness populations [ 10 – 12 ]. However, the diagnosis and management of tobacco smoking related diseases are often limited in this population.…”

Ações em saúde às pessoas idosas consumidoras de substâncias psicoativas

“…The harm reduction program represents a care strategy aimed at increasing the person's degree of freedom and co-responsibility, as users become responsible for their own choices. 11,13 The knowledge derived from the population that consumes PASs is of great relevance to suggest Harm Reduction Strategies (HRS) in a broad perspective of care that does not remove these people from their social reality. [14][15] The analysis of the systemic or organizational principle proposed by Morin showed that understanding such a phenomenon is only possible by starting with the analysis of the parts and the whole at the same time, since the changes that occur in an element will reach the general phenomenon.…”