Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences; University of Massachusetts Memorial Health Center
Behavior and Behavior Mechanisms | Health Services Administration | Health Services Research | Nursing | Substance Abuse and Addiction | Telemedicine
BACKGROUND: Smoking is the leading cause of preventable death and disease, yet implementation of smoking cessation in inpatient settings is inconsistent. The Technology Inpatient Program for Smokers (TIPS) is an implementation program designed to reach smokers with a mobile health (mHealth) intervention using stakeholder-supported strategies.
OBJECTIVE: The purpose of this study was to determine the impact of the TIPS implementation strategies on smoker-level engagement of the mHealth intervention during care transition.
METHODS: We examined varying intensities (passive motivational posters only and posters + active nurse-led facilitation) of TIPS strategies on four hospital units located in two sites. Unit-level and smoker-level adoption was monitored during active implementation (30 weeks) and sustainability follow-up (30 weeks). Process measures reflecting the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, stakeholder reported adaptations of strategies, and formative evaluation data were collected and analyzed.
RESULTS: For our smoker-level reach, 103 smokers signed up for the mHealth intervention in-hospital, with minimal decline during sustainability follow-up. While posters + nurse facilitation did not lead to higher reach than posters alone during active implementation (27 vs 30 signed up), it did lead to higher engagement of smokers (85.2% vs 73.3% completion of the full 2-week intervention). TIPS strategy adoption and fidelity varied by unit, including adoption of motivational posters (range: weeks 1 and 5), fidelity of posters (0.4% to 16.2% of posters missing per unit weekly) and internal facilitation of nurse training sessions (average of 2 vs 7.5 by site). Variable maintenance costs of the program totaled US $6.63 (US $683.28/103) per smoker reached. Reported family-member facilitation of mHealth sign-up was an observation of unintended behavior.
CONCLUSIONS: TIPS is a feasible and low-cost implementation program that successfully engages smokers in an mHealth intervention and sustains engagement after discharge. Further testing of nurse facilitation and expanding reach to patient family and friends as an implementation strategy is needed.
care transition, implementation strategy, mHealth, tobacco use cessation, mobile health, patient transfer, smoking, smoking cessation, telemedicine, tobacco
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© Amanda C Blok, Rajani S Sadasivam, Timothy P Hogan, Angela Patterson, Nicole Day, Thomas K Houston. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 30.09.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.
DOI of Published Version
JMIR Mhealth Uhealth. 2019 Oct 4;7(10):e14331. doi: 10.2196/14331. Link to article on publisher's site
JMIR mHealth and uHealth
Blok AC, Sadasivam RS, Hogan TP, Patterson A, Day N, Houston TK. (2019). Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study. Open Access Articles. https://doi.org/10.2196/14331. Retrieved from https://escholarship.umassmed.edu/oapubs/3990
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This work is licensed under a Creative Commons Attribution 4.0 License.