JMIR Publications

ABSTRACT

Tobacco smoking is associated with significant morbidity and premature mortality in those with serious mental illness. People with serious mental illness appear to be less likely to quit and more likely to relapse without pharmacotherapeutic smoking cessation aids, yet few are prescribed effective tobacco dependence pharmacologic treatment with behavioral treatment. We conducted a pragmatic trial to test the effectiveness of two-year, systems-level intervention components comprised of targeted smoking cessation education to primary care physicians termed academic detailing and community health worker support for tobacco cessation treatment on improving provision of first-line smoking cessation pharmacotherapy and abstinence rates and found a significant impact of community health worker support on abstinence. The dissemination, scaling, and expansion to other settings of a systems intervention found effective in a pragmatic trial calls for systematic identification of barriers and facilitators to implementation, relevant subgroups, effective and unique components, and setting-specific factors. We aim to accomplish this purpose by leveraging qualitative and quantitative data sources in a mixed methods evaluation of this pragmatic trial to 1) identify qualitatively barriers and facilitators to effective implementation of the intervention for community health workers, participants, and primary care providers (PCPs); 2) examine how primary care physicians grouped at the clinic level differ by quantitative performance and engagement level, and how their experiences with the intervention components, barriers and facilitators, compare across these groups; 3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate impacting the implementation of effective components of the systems level smoking cessation intervention tested. Qualitative interviews will be conducted with all study CHWs and selected participants, providers, and other stakeholders. Measures of performance and engagement will guide the purposive sampling of these stakeholders. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance to the framework approach 1) Familiarization, 2) Identifying a Thematic Framework, 3) Indexing, 4) Charting, and 5) Mapping and Interpretation. Joint display analyses will be constructed to facilitate meta-inferences. The results of this mixed methods implementation evaluation will inform development of strategies for dissemination and solutions to potential barriers to implementation of the pragmatic trial intervention. This will then enhance the systematic implementation and dissemination into other settings in future initiatives of smoking cessation for those with serious mental illness.