Abstract
BackgroundThe Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded.MethodsSix hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged.ResultsSustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program.ConclusionsApplying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program sustainability, and foster development of a sustainability plan. Based on this study, we suggest that sustainability plans should focus on enhancing interactions between the health problem, program features, and stakeholder influence.
Highlights
The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada
One decision maker (DM) and one smoking cessation coordinator (SCC) were interviewed at each participating hospital with two exceptions; we were unable to interview the DM at one hospital, and at another we interviewed two DMs at their request
We found that applying the Gruen et al model [21] and examining the interactions between the health problem, the program, and program drivers, provided greater insight into the sustainability of the Ottawa Model for Smoking Cessation (OMSC)
Summary
The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded. Smoking cessation interventions provided to hospitalized smokers have been shown to Numerous studies have examined the effectiveness of hospital smoking cessation programs [7]. The authors found that no site had maintained a smoking cessation intervention to reach all hospitalized smokers; one site maintained a disease management program for secondary prevention of cardiac disease that includes counselling, and a second site provided smoking cessation intervention at the hospital through a consultation service, if the attending physician made a referral [8]. The authors noted that constraints on financial and staff resources, lack of system supports for the recommended cessation activities, and the need for continued staff support and performance feedback were major barriers to institutionalization
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