Implementation mapping for tobacco cessation in a federally qualified health center.

Abstract

Background

Implementation mapping (IM) is a promising five-step method for guiding planning, execution, and maintenance of an innovation. Case examples are valuable for implementation practitioners to understand considerations for applying IM. This pilot study aimed to determine the feasibility of using IM within a federally qualified health center (FQHC) with limited funds and a 1-year timeline.

Methods

An urban FQHC partnered with an academic team to employ IM for implementing a computerized strategy of tobacco cessation: the 5A's (Ask, Advise, Assess, Assist, Arrange). Each step of IM was supplemented with theory-driven methods and frameworks. Data collection included surveys and interviews with clinic staff, analyzed via rapid data analysis.

Results

Medical assistants and clinicians were identified as primary implementers of the 5A's intervention. Salient determinants of change included the perceived compatibility and relative priority of 5A's. Performance objectives and change objectives were derived to address these determinants, along with a suite of implementation strategies. Despite indicators of adoptability and acceptability of the 5A's, reductions in willingness to adopt the implementation package occurred over time and the intervention was not adopted by the FQHC within the study timeframe. This is likely due to the strain of the COVID-19 pandemic altering health clinic priorities.

Conclusions

Administratively, the five IM steps are feasible to conduct with FQHC staff within 1 year. However, this study did not obtain its intended outcomes. Lessons learned include the importance of re-assessing barriers over time and ensuring a longer timeframe to observe implementation outcomes.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.3389/fpubh.2022.908646

Publication Info

Domlyn, Ariel M, Carolyn Crowder, Howard Eisenson, Kathryn I Pollak, James M Davis, Patrick S Calhoun and Sarah M Wilson (2022). Implementation mapping for tobacco cessation in a federally qualified health center. Frontiers in public health, 10. p. 908646. 10.3389/fpubh.2022.908646 Retrieved from https://hdl.handle.net/10161/26274.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Pollak

Kathryn IIonka Pollak

Professor in Population Health Sciences

Dr. Pollak is a social psychologist who designs and tests behavioral interventions to promote smoking cessation, reduce health disparities, and improve clinician-patient communication. She also is one of the Multiple Principal Investigators of the Palliative Care Research Cooperative that supports multi-site palliative care trials. Finally, Dr. Pollak serves as a Communication Coach where she teaches clinicians effective communication techniques.

Area of expertise: Health Behavior

Davis

James Davis

Associate Professor of Medicine

Dr. James Davis is a practicing physician of Internal Medicine, and serves as the Medical Director for Duke Center for Smoking Cessation, Director of the Duke Smoking Cessation Program and Co-Director of the Duke-UNC Tobacco Treatment Specialist Credentialing Program.  His research focuses on development of new pharmaceutical treatments for smoking cessation.  He is principal investigator on several trials including a study on “adaptive” smoking cessation and several trials on new medications for smoking cessation. The new medications leverage more novel neurobiological mechanisms - NMDA receptor antagonism, nicotinic receptor antagonism, which impact addiction-based learning and cue response. Additionally, Dr. Davis serves as co-investigator on trials on lung cancer screening, e-cigarettes, minor nicotine alkaloids, imaging trials, lung function trials and others. Dr. Davis leads the Duke Smoke-Free Policy Initiative, is co-author on a national  tobacco dependence treatment guideline, and provides training in tobacco dependence treatment for the Duke School of Medicine, Duke Internal Medicine, Family Practice and Psychiatry residency programs.

Calhoun

Patrick Shields Calhoun

Professor in Psychiatry and Behavioral Sciences

I specialize in the assessment and treatment of the psychological and behavioral sequelae of posttraumatic stress disorder (PTSD) including the use of cognitive-behavioral interventions to reduce PTSD symptoms, aggression, and substance misuse.

 Research interests

  • The psychological, behavioral, and health consequences of traumatic stress
  • Health services research related to PTSD and associated behavioral difficulties
  • Identification of innovative health behavior change interventions to reduce smoking, alcohol, and drug misuse
  • Implementation Science
  • Psychometric assessment and methodology
Wilson

Sarah M Wilson

Assistant Professor in Psychiatry and Behavioral Sciences

Sarah M. Wilson is an Assistant Professor in the Department of Psychiatry & Behavioral Sciences at the Duke University School of Medicine, with a secondary appointment in the Department of Population Health Sciences and a faculty affiliation in the Duke Center for Health Policy and Inequalities Research. She is a Research Investigator and Co-Lead of the Diversity, Equity, and Inclusion Core at the Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT COIN). She also serves as the Associate Director of the Duke Center for AIDS Research Social and Behavioral Sciences Core.

Dr. Wilson's research focuses on access to care and systems-level healthcare change to improve inequities in populations who experience systemic discrimination, including Black, Indigenous, and People of Color (BIPOC), individuals with low income, sexual and gender minorities, and specific populations of U.S. Military Veterans. Her clinical work as a licensed clinical psychologist focuses on mental health care for patients with comorbid mental health concerns and stress due to systemic discrimination, as well as training for health care professionals on LGBTQ-affirmative care.

Dr. Wilson has expertise in health equity, social determinants of health, community engagement, intervention development, and implementation science. She is a former Fellow in the Implementation Research Institute. She leads VA and NIH research studies related to implementation science and health equity in the areas of tobacco cessation, provider implicit bias, pre-exposure prophylaxis for HIV, and LGBTQ-affirmative mental healthcare.


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