Using Rural Community Paramedicine to Engage Lower-Motivated Smokers: Spreading an Effective mHealth-Assisted Intervention to Motivate Cessation

利用农村社区辅助医疗吸引动机较低的吸烟者：传播有效的移动医疗辅助干预措施以激励戒烟

• 批准号: 10552308
• 负责人: Thomas K Houston
• 金额: $ 74.86万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-05 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10552308
• 关键词: Abstinence; Address; Adult; Appalachian Region; Area; Attention; Carbon Monoxide; Chronic Disease; Clinic; Clinical Services; Code; Communities; Complex; County; Data; Emergency medical service; Employee; Equilibrium; Funding; Future; Geography; Goals; Human Resources; Hybrids; Individual; Institution; Internal Medicine; Intervention; Knowledge; Monitor; North Carolina; Odds Ratio; Palate; Participant; Pathway Analysis; Pathway interactions; Patients; Personnel Staffing; Persons; Prevalence; Preventive Medicine; Process; Protocols documentation; Publishing; Randomized; Recording of previous events; Reporting; Research; Role; Rural; Rural Community; Rural Health; Sampling; Science; Self Efficacy; Services; Smoke; Smokeless Tobacco; Smoker; Smoking; Smoking Behavior; Technology; Testing; Thinking; Time; Tobacco use; Training; Variant; Vulnerable Populations; Work; budget impact; cancer prevention; comparison group; cost; design; digital; effectiveness outcome; effectiveness research; effectiveness trial; evidence base; experience; health care delivery; high reward; high risk; implementation cost; implementation evaluation; implementation fidelity; implementation outcomes; implementation research; implementation strategy; implementation trial; innovation; mHealth; nicotine cessation; nicotine replacement; novel; population health; programs; routine practice; rural area; rural counties; skills; smoking cessation; smoking prevalence; success; tobacco control; vaping

7. Project Summary/Abstract We will conduct a multi-level “hybrid type 2” study (i.e.: implementation and effectiveness outcomes) to test 1) a novel implementation program in rural counties and 2) a mHealth (mobile health)-assisted brief abstinence experience (Take a Break, TAB) for rural adults who smoke and are not-yet-ready to quit. In our network of rural counties, the implementation trial will use a novel, multi-strategy implementation program centered on county employees engaged in ‘community paramedicine.’ Emergency Medical Services personnel (EMS) are evolving into this more expansive role (e.g.: non-emergent healthcare delivery, monitoring of chronic disease, and preventive medicine). To test the implementation, we will randomize rural counties with EMS serving geographically complex and ethnically varied areas (the mountainous region of Appalachia and plains of eastern North Carolina). These counties have some of the highest smoking rates in the U.S. We will compare a well- tested (standard) implementation program versus a novel enhanced program. The standard program uses evidence-based external facilitation – providing training and technical support to EMS services to support the integration of enhanced tobacco control practices (including recommending and referring people who smoke and not-yet-ready-to-quit to the mHealth-assisted population health intervention. The novel enhanced implementation program will include the standard program an EMS Champion program. EMS who currently smoke will be offered participation in TAB themselves. Those who participate, Champions, will then use their TAB experience to support implementation as internal facilitators. They will encourage other EMS to experience TAB, longitudinally encourage use of the tobacco control practices in routine workflow for all EMS, and will be able to use their personal experience with TAB to engage in a richer dialog with patients who smoke. Using these strategies, we seek to engage individuals living in harder-to-reach rural areas with less access to clinical services. Engaging these individuals is possible with brief, low intensity, palatable interventions that target self-efficacy and facilitate skills building to support future abstinence. The TAB intervention addresses the challenge of engaging lower motivated individuals using a novel format, a brief abstinence game, supported using mHealth and building upon 10 years of research. We recently published the first TAB effectiveness trial in JAMA Internal Medicine. This preliminary data supports the current application and does not include a large number of individuals living in rural areas. In this project, we will randomize to TAB versus an active comparison designed to isolate the effect of TAB and balance the participant contact across the two groups. In addition to evaluating implementation success and effectiveness outcomes, we will study pathways to cessation. To inform sustainment and dissemination, we will collect data on implementation fidelity, county-level adaptations, variations in referrals, and patient-level engagement across the counties, and at the EMS and patient-level. To evaluate budget impact, we will track the cost of the implementation strategies and the intervention.

7. 项目总结/文摘