Abstract
BackgroundSmoking 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 a mobile health (mHealth) intervention using stakeholder-supported strategies.ObjectiveThe 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.MethodsWe 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 reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, stakeholder reported adaptations of strategies, and formative evaluation data were collected and analyzed.ResultsFor 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 vs 30 signed up), it did lead to higher engagement of smokers (85.2% vs 73.3% completion of the full 2-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 vs 7.5 by site). Variable maintenance costs of the program totaled US $6.63 (US $683.28/103) per smoker reached. Reported family-member facilitation of mHealth sign-up was an observation of unintended behavior.ConclusionsTIPS 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.
Highlights
MethodsTobacco use is the primary preventable cause of death and disease in the United States [1]
We developed an implementation program called the Technology Inpatient Program for Smokers (TIPS) to support the use of an mobile health (mHealth) intervention designed to continue engaging smokers during transition into the outpatient setting [13]
Our mHealth intervention is the first Quit Smoking texting system to be offered to patients in hospital units for continued use after discharge
Summary
Tobacco use is the primary preventable cause of death and disease in the United States [1]. Tobacco use is a major risk factor for many chronic illnesses that commonly result in hospitalization, such as cancer, heart and lung diseases, chronic obstructive pulmonary disease, and diabetes [1]. Hospitalization is a unique period of forced abstinence, and this is an opportunity to engage smokers and motivate them to be smoke free as they transition home after discharge [1]. Continual engagement with tobacco cessation support can be a challenge when transitioning away from the clinical setting. 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 a mobile health (mHealth) intervention using stakeholder-supported strategies
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