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A Mixed-Methods Assessment of a Brief Smoking Cessation Intervention Implemented in Ohio Public Health Clinics, 2013

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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.

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Acknowledgments

This study was supported by means of the Epi-Aid mechanism, Epidemic Intelligence Service, Centers for Disease Control and Prevention (Epi-Aid #2013-038). This study also received support in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1U38OT000143-02. The authors acknowledge the following for their contributions to this study: Ohio Partners for Smoke-Free Families; the Epidemic Intelligence Service Program; and Brian King, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Israel T. Agaku & Nicole M. Kuiper

  2. Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Israel T. Agaku, Oluwatosin Olaiya & Celia Quinn

  3. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Oluwatosin Olaiya, Van T. Tong, Elizabeth J. Conrey, Andrea J. Sharma & Deborah Dee

  4. Ohio Department of Health, Columbus, OH, USA

    Celia Quinn, Elizabeth J. Conrey & Sierra Mullen

  5. U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA

    Celia Quinn, Andrea J. Sharma & Deborah Dee

  6. CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA

    Sierra Mullen

Authors
  1. Israel T. Agaku
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  2. Oluwatosin Olaiya
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  3. Celia Quinn
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  4. Van T. Tong
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  5. Nicole M. Kuiper
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  6. Elizabeth J. Conrey
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  7. Andrea J. Sharma
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  8. Sierra Mullen
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  9. Deborah Dee
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Corresponding author

Correspondence to Israel T. Agaku.

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Agaku, I.T., Olaiya, O., Quinn, C. et al. A Mixed-Methods Assessment of a Brief Smoking Cessation Intervention Implemented in Ohio Public Health Clinics, 2013. Matern Child Health J 19, 2654–2662 (2015). https://doi.org/10.1007/s10995-015-1786-y

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  • DOI: https://doi.org/10.1007/s10995-015-1786-y

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