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

7.项目摘要/摘要 我们将进行一项多层次的“混合类型2”研究(即：实施和成效成果)以测试 1)农村县的新实施方案和2)移动健康(移动医疗)辅助的短暂禁欲 为吸烟但尚未准备戒烟的农村成年人提供经验(休息一下，TAB)。在我们的农村网络中 实施试点将采用以县为中心的新颖、多战略实施方案 从事“社区辅助医疗”的员工。急救医疗服务人员(EMS)正在发展 进入这一更广泛的角色(例如：非紧急医疗保健提供、慢性疾病监测和 预防医学)。为了测试实施情况，我们将随机选择有EMS服务的农村县 地理复杂和民族多样的地区(阿巴拉契亚山区和东部平原 北卡罗来纳州)。这些县是美国吸烟率最高的县之一。我们将比较一下- 测试(标准)实施计划与新的增强计划。标准程序使用 循证对外便利化-为EMS服务提供培训和技术支持，以支持 整合强化的烟草控制做法(包括推荐和转介吸烟者和 尚未准备好放弃移动健康辅助的人群健康干预。小说的增强型 实施计划将包括标准计划和EMS冠军计划.当前的EMS人员 Smoke将被允许参与TAB本身。参赛者，冠军，然后将使用他们的 TAB经验，作为内部推动者支持实施。他们将鼓励其他EMS体验 选项卡，纵向鼓励在所有EMS的日常工作流程中使用烟草控制做法，并将 能够利用他们与TAB的个人经验与吸烟患者进行更丰富的对话。使用这些 通过这一战略，我们寻求让生活在较难接触到的农村地区、获得临床服务机会较少的个人参与进来。 通过以自我效能为目标的简短、低强度、令人愉快的干预，可以让这些人参与进来 并促进技能建设，以支持未来的禁欲。TAB干预解决了以下挑战 使用一种新的形式吸引动机较低的个人参与，这是一个短暂的禁欲游戏，由mHealth支持 并建立在10年研究的基础上。我们最近在《美国医学会内科杂志》上发表了首个TAB有效性试验 医学。这一初步数据支持当前的应用，不包括大量 生活在农村地区的个人。在这个项目中，我们将随机分成TAB和设计的积极比较 以隔离TAB的影响，并平衡两组参与者的接触。除了评估 根据实施成功和成效结果，我们将研究停止的途径。通知 为了支持和传播，我们将收集关于执行保真度、县级适应、 各县之间以及急救服务和患者层面的转诊和患者层面的参与度存在差异。至 评估预算影响时，我们将跟踪实施战略和干预的成本。

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.