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Implementation of Community Health Worker Support for Tobacco Cessation: A Mixed-Methods Study.
Foo, Cheryl Y S; Potter, Kevin; Nielsen, Lindsay; Rohila, Aarushi; Maravic, Melissa Culhane; Schnitzer, Kristina; Pachas, Gladys N; Levy, Douglas E; Reyering, Sally; Thorndike, Anne N; Cather, Corinne; Evins, A Eden.
Afiliación
  • Foo CYS; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Potter K; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Nielsen L; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Rohila A; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Maravic MC; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Schnitzer K; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Pachas GN; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Levy DE; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Reyering S; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Thorndike AN; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Cather C; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
  • Evins AE; Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Ca
Psychiatr Serv ; : appips20240044, 2024 Aug 09.
Article en En | MEDLINE | ID: mdl-39118574
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Psychiatr Serv Asunto de la revista: PSIQUIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Psychiatr Serv Asunto de la revista: PSIQUIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos