Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers

Abstract

Tobacco use is disproportionately elevated among patients with substance use disorders relative to the general U.S. population. Tobacco interventions are lacking within substance use treatment centers (SUTCs) due to lack of knowledge and training. This study examined knowledge gain and the organizational factors that might moderate knowledge gains following tobacco education training provided to employees (N = 580) within 15 SUTCs that were participating in a tobacco-free workplace program. The number of total annual patient visits, unique annual patient visits, number of full-time employees, and organizational readiness for implementing change (ORIC) as assessed prior to implementation were examined as potential moderators. Results demonstrated significant knowledge gain (p < 0.001) after training overall; individually, 13 SUTCs had significant knowledge gain (p’s < 0.014). SUTCs with fewer total annual patient visits and fewer full-time employees showed greater knowledge gains. The ORIC total score and all but one of its subscales (Resource Availability) moderated knowledge gain. SUTCs with greater initial Change Efficacy (p = 0.029), Valence (p = 0.027), and Commitment (p < 0.001) had greater knowledge gain than SUTCs with lower scores on these constructs; SUTCs with greater Task Knowledge (p < 0.001) regarding requirements for change exhibited less knowledge gain. Understanding the organizational-level factors impacting training effectiveness can inform efforts in organizational change and tobacco control program implementation.

Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers

“…Other studies suggest that increasing clinicians’ provision of evidence-based interventions may increase quit attempts and promote reduced tobacco use during treatment among patients with substance use disorders who smoke [ 28 , 32 ]. Thus, the present results add to the literature supporting the implementation of these programs to expand a substance use treatment center’s capacity to screen for and intervene on tobacco use, which may ultimately affect the tobacco use and tobacco-related disease inequities among individuals with substance use disorders [ 15 , 23 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 44 ]. Results also demonstrated that organizational readiness for change moderated these changes in intervention delivery; specifically, substance use treatment centers with greater initial Change Efficacy demonstrated greater increases in Asking about tobacco use, whereas substance use treatment centers with lower Resource Availability demonstrated greater increases in Asking about tobacco use as well as Assessing willingness to quit tobacco.…”

“…Of these substance use treatment centers, many served unique populations, such as individuals who are experiencing homelessness, vulnerably housed, pregnant, and/or involved with the criminal justice system. These characteristics of the substance use treatment centers are described further in a separate study [ 41 ].…”

“…Taking Texas Tobacco Free has been implemented throughout Texas in behavioral health treatment settings and substance use treatment centers [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Implementation outcome data have supported significant increases in tobacco-related knowledge among employees, increases in clinicians’ self-reported use of the five As, and increases in organizational capacity for tobacco intervention provision to patients [ 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 ]. The five As are an evidence-based, brief tobacco cessation intervention that has been recommended in clinical treatment guidelines [ 29 , 42 ].…”

Implementation and Outcomes of a Train-the-Trainer Program at Behavioral Health Treatment Centers as a Mechanism to Maintain Organizational Capacity to Address Tobacco Use Disorder

“…Future work will need to assess the impacts of this program on the sustainment of all evidence-based tobacco use policies and practices as associated with a comprehensive tobacco-free workplace program (e.g., compliance with the tobacco-free workplace policy, provision of tobacco screening and treatment to patients), which was beyond the scope and timeline of the underlying grant. However, results speak to the potential upkeep of one major component of the TTTF comprehensive tobacco-free workplace program: the provision of employee education about addressing tobacco use amongst their behavioral health patients, which has previously been associated with increased screening and treatment of tobacco use [ 15 , 22 , 23 , 24 ]. An important future direction of this work is to evaluate whether TTTF’s train-the-trainer program’s implementation was linked with clinician behavior change and, ultimately, reduced patient tobacco use rates.…”

“…An example item was, “Which of the following is NOT one of the “5As” or tobacco cessation brief intervention?” with answer options (a) ask; (b) arrange; (c) assess; and (d) allow. This measure has been used in our prior work [ 12 , 15 , 22 , 23 , 24 ]. No personally identifying information about the employee was collected on this survey at either administration.…”