Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Nicotine Tob Res. 2019 Jan 4;21(2):180-187. doi: 10.1093/ntr/ntx232.
The Smoke-Free Homes (SFH) Program is an evidence-based intervention offered within 2-1-1 information and referral call centers to promote smoke-free homes in low-income populations. We used the Consolidated Framework for Implementation Research to conduct a mixed-methods analysis of facilitators and barriers to scaling up SFH to five 2-1-1 sites in the United States.
Data were collected from staff in 2015-2016 via online surveys administered before (N = 120) and after SFH training (N = 101) and after SFH implementation (N = 79). Semi-structured telephone interviews were conducted in 2016 with 25 staff to examine attitudes towards SFH, ways local context affected implementation, and unintended benefits and consequences of implementing SFH.
Post-implementation, 79% of respondents reported that SFH was consistent with their 2-1-1's mission, 70% thought it led to more smoke-free homes in their population, 62% thought it was easy to adapt, and 56% thought participants were satisfied. Composite measures of perceived appropriateness of SFH for 2-1-1 callers and staff positivity toward SFH were significantly lower post-implementation than pre-implementation. In interviews, staff said SFH fit with their 2-1-1's mission but expressed concerns about intervention sustainability, time and resources needed for delivery, and how SFH fit into their workflow.
Sites' SFH implementation experiences were affected both by demands of intervention delivery and by SFH's perceived effectiveness and fit with organizational mission. Future implementation of SFH and other tobacco control programs should address identified barriers by securing ongoing funding, providing dedicated staff time, and ensuring programs fit with staff workflow.
Smoke-free home policies reduce exposure to secondhand smoke. Partnering with social service agencies offers a promising way to scale up evidence-based smoke-free home interventions among low-income populations. We found that the SFH intervention was acceptable and feasible among multiple 2-1-1 delivery sites. There were also significant challenges to implementation, including site workflow, desire to adapt the intervention, time needed for intervention delivery, and financial sustainability. Addressing such challenges will aid future efforts to scale up evidence-based tobacco control interventions to social service agencies such as 2-1-1.
无烟家庭（SFH）计划是一项基于证据的干预措施，在 2-1-1 信息和转介呼叫中心提供，以促进低收入人群的无烟家庭。我们使用实施研究综合框架对在美国五个 2-1-1 地点扩大 SFH 的促进因素和障碍进行了混合方法分析。
2015-2016 年，通过在线调查收集员工数据，在 SFH 培训前（N = 120）和培训后（N = 101）以及实施后（N = 79）进行。2016 年，对 25 名员工进行了半结构化电话访谈，以研究他们对 SFH 的态度、当地环境对实施的影响以及实施 SFH 的意外收益和后果。
实施后，79%的受访者表示 SFH 符合他们的 2-1-1 使命，70%的人认为它导致他们的人群中有更多的无烟家庭，62%的人认为它很容易适应，56%的人认为参与者满意。SFH 对 2-1-1 呼叫者的适当性和员工对 SFH 的积极性的综合衡量指标在实施后明显低于实施前。在访谈中，员工表示 SFH 符合他们的 2-1-1 使命，但对干预可持续性、交付所需的时间和资源以及 SFH 如何融入他们的工作流程表示担忧。
各地点的 SFH 实施经验既受到干预交付的需求影响，也受到 SFH 有效性和与组织使命的一致性的影响。未来应通过确保持续资金、提供专门的员工时间并确保计划符合员工工作流程来解决确定的障碍，以实施 SFH 和其他烟草控制计划。
无烟家庭政策可减少二手烟暴露。与社会服务机构合作是在低收入人群中扩大基于证据的无烟家庭干预措施的一种很有前途的方式。我们发现，SFH 干预措施在多个 2-1-1 提供地点是可以接受和可行的。在实施过程中也存在重大挑战，包括现场工作流程、对干预措施的适应愿望、干预措施交付所需的时间以及财务可持续性。解决这些挑战将有助于未来努力向 2-1-1 等社会服务机构扩大基于证据的烟草控制干预措施。
