Department of Family & Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ (AMA, MLM, JC, TEC, BAM, ADB).
J Addict Med. 2019 Nov/Dec;13(6):470-475. doi: 10.1097/ADM.0000000000000522.
Despite progress in reducing tobacco use within the general population, high prevalence of tobacco use continues in individuals with mental health and substance use disorders ("clients"). Tobacco use persists as the leading cause of premature mortality in this population. While behavioral health providers have frequent contacts with this population, they lack training in tobacco cessation counseling.
We conducted multimethod formative data collection consisting of key informant interviews with providers, field observations at clinical sites, and structured group interviews with behavioral health providers, and, separately, clients. Activities were conducted at 4 behavioral health agencies with 9 behavioral health clinic sites in southern Arizona. Recurring phrases and level of repetition were quantified to identify themes. These themes were then used to adapt the method of training delivery and revise the curriculum content for providers at the participating sites.
Results indicated that providers had "training fatigue" and low satisfaction with multiple, online trainings. Further, providers noted issues including time constraints, competing clinical priorities, and low access to tobacco-cessation materials. Clients demonstrated high self-awareness around the importance of quitting smoking and professed frustration at being unable to quit, despite multiple attempts. Finally, both providers and clients agreed that a personal, supportive approach to cessation counseling was preferred.
Using results from this formative research to revise delivery and content of existing smoking-cessation training for behavioral health providers may address barriers to assisting clients with smoking cessation. Additional research to determine the efficacy of the adapted training is needed.
尽管在普通人群中减少烟草使用方面取得了进展，但精神健康和药物使用障碍患者（“患者”）中的烟草使用仍很普遍。在该人群中，烟草使用仍然是导致过早死亡的主要原因。尽管行为健康提供者经常与该人群接触，但他们缺乏戒烟咨询方面的培训。
我们进行了多方法形成性数据收集，包括与提供者的关键知情人访谈、临床现场的实地观察以及与行为健康提供者的结构化小组访谈，以及与客户的单独访谈。活动在亚利桑那州南部的 4 个行为健康机构和 9 个行为健康诊所进行。通过定量重复出现的短语和重复次数来确定主题。然后，这些主题被用于调整培训交付方式，并为参与地点的提供者修改课程内容。
结果表明，提供者存在“培训疲劳”，并且对多次在线培训的满意度较低。此外，提供者还指出了一些问题，包括时间限制、竞争的临床重点以及获取戒烟材料的机会有限。患者对戒烟的重要性有很高的自我意识，并表示尽管多次尝试，但仍无法戒烟感到沮丧。最后，提供者和患者都同意，他们更希望采用个性化、支持性的戒烟咨询方法。
使用这项形成性研究的结果来修改现有的行为健康提供者戒烟培训的交付方式和内容可能有助于解决帮助患者戒烟的障碍。需要进行更多的研究来确定改编后的培训的效果。
