Israel T Agaku1,2, Oluwatosin Olaiya3,4, Celia Quinn5,6,7, Van T Tong8, Nicole M Kuiper9, Elizabeth J Conrey10,11, Andrea J Sharma12,13, Sierra Mullen14,15, Deborah Dee16,17. 1. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. iagaku@cdc.gov. 2. Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. iagaku@cdc.gov. 3. Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. xdg1@cdc.gov. 4. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. xdg1@cdc.gov. 5. Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. fyq6@cdc.gov. 6. Ohio Department of Health, Columbus, OH, USA. fyq6@cdc.gov. 7. U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA. fyq6@cdc.gov. 8. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. vct2@cdc.gov. 9. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. nKuiper@cdc.gov. 10. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. ElizabethJ.Conrey@odh.ohio.gov. 11. Ohio Department of Health, Columbus, OH, USA. ElizabethJ.Conrey@odh.ohio.gov. 12. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. aec4@cdc.gov. 13. U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA. aec4@cdc.gov. 14. Ohio Department of Health, Columbus, OH, USA. Sierra.Mullen@odh.ohio.gov. 15. CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA. Sierra.Mullen@odh.ohio.gov. 16. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. DDee@cdc.gov. 17. U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA. DDee@cdc.gov.
Abstract
OBJECTIVES: In 2006, the state of Ohio initiated the implementation of a brief smoking cessation intervention (5As: Ask, Advise, Assess, Assist, and Arrange) in select public health clinics that serve low-income pregnant and post-partum women. Funds later became available to expand the program statewide by 2015. However, close to half of the clinics initially trained stopped implementation of the 5As. To help guide the proposed statewide expansion plan for implementation of the 5As, this study assessed barriers and facilitators related to 5As implementation among clinics that had ever received training. METHODS: A mixed-methods approach was used, comprising semi-structured interviews with clinic program directors (n = 21) and a survey of clinic staff members (n = 120), to assess implementation-related barriers, facilitators, training needs, and staff confidence in delivering the 5As. RESULTS: Semi-structured interviews of program directors elucidated implementation barriers including time constraints, low self-efficacy in engaging resistant clients, and paperwork-related documentation challenges. Facilitators included availability of community referral resources, and integration of cessation interventions into the clinic workflow. Program directors believed they would benefit from more hands-on training in delivering the 5As. The survey results showed that a majority of staff felt confident advising (61%) or referring clients for tobacco dependence treatment (74%), but fewer felt confident about discussing treatment options with clients (29%) or providing support to clients who had relapsed (30%). CONCLUSIONS: Time constraints and documentation issues were major barriers to implementing the 5As. Simplified documentation processes and training enhancements, coupled with systems change, may enhance delivery of evidence-based smoking cessation interventions.
OBJECTIVES: In 2006, the state of Ohio initiated the implementation of a brief smoking cessation intervention (5As: Ask, Advise, Assess, Assist, and Arrange) in select public health clinics that serve low-income pregnant and post-partum women. Funds later became available to expand the program statewide by 2015. However, close to half of the clinics initially trained stopped implementation of the 5As. To help guide the proposed statewide expansion plan for implementation of the 5As, this study assessed barriers and facilitators related to 5As implementation among clinics that had ever received training. METHODS: A mixed-methods approach was used, comprising semi-structured interviews with clinic program directors (n = 21) and a survey of clinic staff members (n = 120), to assess implementation-related barriers, facilitators, training needs, and staff confidence in delivering the 5As. RESULTS: Semi-structured interviews of program directors elucidated implementation barriers including time constraints, low self-efficacy in engaging resistant clients, and paperwork-related documentation challenges. Facilitators included availability of community referral resources, and integration of cessation interventions into the clinic workflow. Program directors believed they would benefit from more hands-on training in delivering the 5As. The survey results showed that a majority of staff felt confident advising (61%) or referring clients for tobacco dependence treatment (74%), but fewer felt confident about discussing treatment options with clients (29%) or providing support to clients who had relapsed (30%). CONCLUSIONS: Time constraints and documentation issues were major barriers to implementing the 5As. Simplified documentation processes and training enhancements, coupled with systems change, may enhance delivery of evidence-based smoking cessation interventions.
Authors: Erica J Ambeba; Lei Ye; Susan M Sereika; Mindi A Styn; Sushama D Acharya; Mary Ann Sevick; Linda J Ewing; Molly B Conroy; Karen Glanz; Yaguang Zheng; Rachel W Goode; Meghan Mattos; Lora E Burke Journal: J Cardiovasc Nurs Date: 2015 Jan-Feb Impact factor: 2.083
Authors: Robyn Whittaker; Sabrina Matoff-Stepp; Judy Meehan; Juliette Kendrick; Elizabeth Jordan; Paul Stange; Amanda Cash; Paul Meyer; Julie Baitty; Pamela Johnson; Scott Ratzan; Kyu Rhee Journal: Am J Public Health Date: 2012-10-18 Impact factor: 9.308
Authors: Van T Tong; Patricia M Dietz; Brian Morrow; Denise V D'Angelo; Sherry L Farr; Karilynn M Rockhill; Lucinda J England Journal: MMWR Surveill Summ Date: 2013-11-08