Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX.
HEALTH Research Institute, University of Houston, Houston, TX.
Nicotine Tob Res. 2021 Jan 22;23(2):310-319. doi: 10.1093/ntr/ntaa163.
Smoking is elevated amongst individuals with behavioral health disorders, but not commonly addressed. Taking Texas Tobacco Free is an evidence-based, tobacco-free workplace program that addresses this, in-part, by providing clinician training to treat tobacco use in local mental health authorities (LMHAs). This study examined organizational moderators of change in intervention delivery from pre- to post-program implementation.
LMHA leaders completed the Organizational Readiness for Implementing Change (ORIC) and provided organization demographics pre-implementation. Clinicians (N = 1237) were anonymously surveyed about their consistent use of the 5As (Asking about smoking; Advising clientele to quit; Assessing willingness to quit; Assisting them to quit; Arranging follow-up) pre- and post-program implementation. Adjusted generalized linear mixed models were used for analyses (responses nested within LMHAs), with interaction terms used to assess moderation effects.
Clinician delivery of 5As increased pre- to post-implementation (p < .001). LMHAs with fewer employees (ref = ≤300) demonstrated greater increases in Asking, Assessing, and Assisting over time. LMHAs with fewer patients (ref = ≤10 000) evinced greater changes in Asking over time. Less initial ORIC Change Efficacy, Change Commitment, and Task Knowledge were each associated with greater pre- to post-implementation changes in Asking. Less initial Task Knowledge was associated with greater increases in Advising, Assessing, and Assisting. Finally, less initial Resource Availability was associated with greater increases in Assisting (all moderation term ps < .025).
The smallest and least ready LMHAs showed the largest gains in tobacco cessation intervention delivery; thus, low initial readiness was not a barrier for program implementation, particularly when efficacy-building training and resources are provided.
This study examined organizational moderators of increases in tobacco cessation treatment delivery over time following the implementation of a comprehensive tobacco-free workplace program within 20 of 39 LMHAs across Texas (hundreds of clinics; servicing >50% of the state) from 2013 to 2018. Overall, LMHAs with fewer employees and patients, and that demonstrated the least initial readiness for change, evinced greater gains in intervention delivery. Findings add to dissemination and implementation science by supporting that low initial readiness was not a barrier for this aspect of tobacco-free workplace program implementation when resources and clinician training sessions were provided.
在有行为健康障碍的人群中，吸烟率较高，但通常未得到解决。参与德克萨斯州无烟计划（Taking Texas Tobacco Free）是一个基于证据的无烟工作场所计划，部分通过为当地心理健康管理局（LMHA）的临床医生提供治疗烟草使用的培训来解决这一问题。本研究考察了从计划实施前到实施后的干预提供过程中的组织变化的调节因素。
LMHA 领导人完成了组织准备实施变革（Organizational Readiness for Implementing Change，ORIC）调查，并在实施前提供了组织人口统计学数据。临床医生（N=1237）在实施前后匿名调查了他们对 5A（询问吸烟情况；建议客户戒烟；评估戒烟意愿；帮助他们戒烟；安排随访）的一贯使用情况。使用调整后的广义线性混合模型进行分析（响应嵌套在 LMHAs 中），并使用交互项来评估调节效应。
临床医生提供的 5A 服务在实施前到实施后有所增加（p<.001）。员工人数较少的 LMHA（参考值=≤300）在随时间推移时表现出对询问、评估和协助的更大增加。患者人数较少的 LMHA（参考值=≤10000）在随时间推移时对询问的变化更大。初始 ORIC 变革效能、变革承诺和任务知识较低与询问方面的实施前到实施后的变化更大相关。初始任务知识较低与咨询、评估和协助的增加有关。最后，初始资源可用性较低与协助方面的增加更大有关（所有调节项 p<.025）。
最小和最不准备的 LMHA 在烟草戒断干预提供方面取得了最大的收益；因此，低初始准备并不是计划实施的障碍，特别是当提供效能建设培训和资源时。
本研究在 2013 年至 2018 年间，在德克萨斯州 39 个 LMHA 中的 20 个实施了一项全面的无烟工作场所计划后，考察了组织变化调节因素，该计划在 200 多个诊所中实施，服务于全州 50%以上的人群，对烟草戒断治疗的提供进行了长达数年的跟踪。总体而言，员工人数较少和患者较少，且对变革准备程度最低的 LMHA，在干预提供方面取得了更大的收益。研究结果通过支持在提供资源和临床医生培训课程的情况下，低初始准备程度不是该无烟工作场所计划实施的这一方面的障碍，从而为传播和实施科学做出了贡献。
