Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views.

Eliza Skelton,Anthony Shakeshaft,Ashleigh Guillaumier,Marianne Jauncey,Sam Mccrabb,William Wood,Flora Tzelepis,Billie Bonevski,Allison M Salmon

doi:10.3390/ijerph16112050

Abstract

Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF. Staff and client views on the acceptability, facilitators, and barriers to the provision of smoking cessation care were also examined. Methods: This paper presents findings from the qualitative component conducted post-intervention implementation. Face-to-face semi-structured staff interviews (n = 14) and two client focus groups (n = 5 and n = 4) were conducted between September and October 2016. Recruitment continued until data saturation was reached. Thematic analysis was employed to synthesise and combine respondent views and identify key themes. Results: Staff viewed the organizational change intervention as acceptable. Commitment from leadership, a designated champion, access to resources, and the congruence between the change and the facility’s ethos were important facilitators of organizational change. Less engaged staff was the sole barrier to the intervention. Smoking cessation care was deemed suitable. Key facilitators of smoking cessation care included: Written protocols, ongoing training, and visually engaging information. Key barriers of smoking cessation care included: Lack of access to nicotine replacement therapy (NRT) outside of business hours, practical limitations of the database, and concerns about sustainability of NRT. Conclusion: This study develops our understanding of factors influencing the implementation of an organisational change intervention to promote sustainable provision of smoking cessation care in the SIF setting.

Highlights

12 million people worldwide inject drugs [1]
Given the lack of research evidence, the present study aims to explore the acceptability, facilitators, and barriers as viewed by Supervised injecting facilities (SIFs) staff regarding the organisational change intervention to integrate smoking cessation care
This paper reports on the qualitative component of an organisational change intervention to integrate smoking cessation care into routine delivery at an SIF [9]

Summary

Introduction

12 million people worldwide inject drugs [1]. Among people who inject drugs, tobacco smoking is one of the most commonly used substances with prevalence estimates ranging from 84% [2] to 90% [3]. Supervised injecting facilities (SIFs) are accessed by a large number of people who inject drugs and provide basic treatment in addition to facilitating access to other health care services [4]. Such services may be able to integrate smoking cessation care into routine treatment though the acceptability of such care. Organisational change is proposed to facilitate the provision of smoking cessation care into routine delivery in healthcare services [5]. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF.

Objectives

Methods

Conclusion