Implementation of Community Health Worker Support for Tobacco Cessation: A Mixed-Methods Study.

IF 3.3 3区医学 Q1 HEALTH POLICY & SERVICES

Psychiatric services Pub Date : 2024-08-09 DOI:10.1176/appi.ps.20240044

Cheryl Y S Foo, Kevin Potter, Lindsay Nielsen, Aarushi Rohila, Melissa Culhane Maravic, Kristina Schnitzer, Gladys N Pachas, Douglas E Levy, Sally Reyering, Anne N Thorndike, Corinne Cather, A Eden Evins

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引用次数: 0

Abstract

Objective: Adults with serious mental illness have high rates of tobacco use disorder and underuse pharmacotherapy for tobacco cessation. In a previous randomized controlled trial, participants receiving community health worker (CHW) support and education for their primary care providers (PCPs) had higher tobacco abstinence rates at 2 years, partly because of increased initiation of tobacco-cessation pharmacotherapy. The authors aimed to determine the association between CHW-participant engagement and tobacco abstinence outcomes.

Methods: The authors conducted a secondary, mixed-methods analysis of 196 participants in the trial's intervention arm. Effects of the number and duration of CHW visits, number of smoking-cessation group sessions attended, and number of CHW-attended PCP visits on initiation of tobacco-cessation pharmacotherapy and tobacco abstinence were modeled via logistic regression. Interviews with 12 CHWs, 17 patient participants, and 17 PCPs were analyzed thematically.

Results: Year 2 tobacco abstinence was significantly associated with CHW visit number (OR=1.85, 95% CI=1.29-2.66), visit duration (OR=1.51, 95% CI=1.00-2.28), and number of group sessions attended (OR=1.85, 95% CI=1.33-2.58); effects on pharmacotherapy initiation were similar. One to three CHW visits per month across 2 years were optimal for achieving abstinence. Interviews identified CHW-patient engagement facilitators (i.e., trust, goal accountability, skills reinforcement, assistance in overcoming barriers to treatment access, and adherence). Training and supervision facilitated CHW effectiveness; barriers included PCPs' and care teams' limited understanding of the CHW role.

Conclusions: Greater CHW-participant engagement, within feasible dose ranges, was associated with tobacco abstinence among adults with serious mental illness. Implementation of CHW interventions may benefit from further CHW training and integration within clinical teams.

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实施社区卫生工作人员戒烟支持：混合方法研究。

目的：患有严重精神疾病的成年人烟草使用障碍的发病率很高，而且对戒烟药物疗法的使用不足。在之前的一项随机对照试验中，接受社区健康工作者（CHW）支持和初级保健提供者（PCP）教育的参与者在2年后的戒烟率较高，部分原因是戒烟药物治疗的启动率提高了。作者旨在确定CHW参与者的参与与戒烟结果之间的关联：作者对试验干预组的 196 名参与者进行了二次混合方法分析。通过逻辑回归模拟了CHW访问次数和持续时间、参加的戒烟小组会议次数以及CHW参加的初级保健医生访问次数对开始戒烟药物治疗和戒烟的影响。对 12 名社区保健工作者、17 名患者参与者和 17 名初级保健医生的访谈结果进行了专题分析：结果：第 2 年的戒烟率与 CHW 访视次数（OR=1.85，95% CI=1.29-2.66）、访视持续时间（OR=1.51，95% CI=1.00-2.28）和参加小组活动的次数（OR=1.85，95% CI=1.33-2.58）显著相关；对药物治疗启动的影响相似。在两年时间里，每月进行一至三次社区保健员访视是实现戒断的最佳方式。访谈确定了社区保健工作者与患者接触的促进因素（即信任、目标责任、技能强化、协助克服获得治疗的障碍以及坚持治疗）。培训和监督促进了社区保健工作者的有效性；障碍包括初级保健医生和护理团队对社区保健工作者角色的理解有限：结论：在可行的剂量范围内，CHW-参与者更多的参与与重症精神病成人患者戒烟有关。对社区保健工作者进行进一步培训并将其纳入临床团队，可能会有利于社区保健工作者干预措施的实施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychiatric services 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.80

自引率

7.90%

发文量

295

审稿时长

3-8 weeks

期刊介绍： Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Association. The peer-reviewed journal features research reports on issues related to the delivery of mental health services, especially for people with serious mental illness in community-based treatment programs. Long known as an interdisciplinary journal, Psychiatric Services recognizes that provision of high-quality care involves collaboration among a variety of professionals, frequently working as a team. Authors of research reports published in the journal include psychiatrists, psychologists, pharmacists, nurses, social workers, drug and alcohol treatment counselors, economists, policy analysts, and professionals in related systems such as criminal justice and welfare systems. In the mental health field, the current focus on patient-centered, recovery-oriented care and on dissemination of evidence-based practices is transforming service delivery systems at all levels. Research published in Psychiatric Services contributes to this transformation.