Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 10, 2019
Date Accepted: Jul 21, 2019
Nurse-driven Strategies for Inpatient mHealth Implementation: The Technology Inpatient Program for Smokers (TIPS)
ABSTRACT
Background:
Smoking is the leading cause of preventable death and disease, yet implementation of smoking cessation in inpatient settings is inconsistent. The Technology Inpatient Program for Smokers (TIPS) is an implementation program designed to reach smokers with an mHealth intervention using stakeholder-supported strategies.
Objective:
The purpose of this study was to determine the impact of the TIPS implementation strategies on smoker-level engagement of the mHealth intervention during care transition.
Methods:
We examined varying intensities (passive motivational posters only and posters + active nurse-led facilitation) of TIPS strategies on four hospital units, located in two sites. Unit-level and smoker-level adoption was monitored during active implementation (30 weeks) and sustainability follow-up (30 weeks). Process measures reflecting the RE-AIM framework, stakeholder reported adaptations of strategies, and formative evaluation data were collected and analyzed.
Results:
For our smoker-level reach, 103 smokers signed up for the mHealth intervention in-hospital, with minimal decline during sustainability follow-up. While posters + nurse facilitation did not lead to higher reach than posters alone during active implementation (27 versus 30 signed-up), it did lead to higher engagement of smokers (85.2% versus 73.3% completion of the full two-week intervention). TIPS strategy adoption and fidelity varied by unit, including adoption of motivational posters (range: weeks 1 and 5), fidelity of posters (0.4% to 16.2% of posters missing per unit weekly) and internal facilitation of nurse training sessions (average of 2 versus 7.5 by site). Variable maintenance costs of the program totaled $6.63 (683.28/103) per smoker reached. Reported family-member facilitation of mHealth sign-up was an unintended observation.
Conclusions:
TIPS is a feasible and low-cost implementation program that successfully engages smokers in an mHealth intervention and sustains engagement after discharge. Further testing of nurse facilitation and expanding reach to patient family and friends as an implementation strategy is needed.
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