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: 10697314
• 负责人: Thomas K Houston
• 金额: $ 74.11万
• 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/10697314
• 关键词: Abstinence; Address; Adult; Appalachian Region; Area; Attention; Carbon Monoxide; Chronic Disease; Clinic; Clinical Services; Code; Communication; Communities; Complex; County; Data; Electronics; Emergency medical service; Employee Engagement; Equilibrium; Ethnic Origin; Funding; Future; Geography; Goals; Human Resources; Hybrids; Individual; Institution; Internal Medicine; Intervention; Knowledge; Monitor; North Carolina; Odds Ratio; Participant; Pathway Analysis; Pathway interactions; Patients; Personnel Staffing; Persons; Prevalence; Preventive Medicine; Process; Protocols documentation; Publishing; Randomized; Recommendation; Recording of previous events; Reporting; Research; Role; Rural; Rural Community; Rural Health; Rural Population; Sampling; Science; Self Efficacy; Services; Smoke; Smokeless Tobacco; Smoker; Smoking; Smoking Behavior; Technology; Testing; Thinking; Time; Tobacco use; Training; Urban Population; 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; patient engagement; patient level intervention; patient navigation; patient navigator; 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。项目摘要/摘要 我们将进行多层次的“混合型2”研究（即实施和有效性结果）以测试 1）在农村县的新实施计划和2）MHealth（移动健康）的短暂节制 对于那些吸烟并且还不准备戒烟的艰难成年人的经验（休息一下）。在我们的农村网络中 县，实施审判将使用以县为中心的新颖的多策略实施计划 从事“社区护理人员”的员工。紧急医疗服务人员（EMS）正在发展 进入这种更广泛的角色（例如：非急性医疗保健提供，监测慢性病和 预防医学）。为了测试实施，我们将使用EMS服务随机将粗糙的县随机化 地理上复杂的和种族多样的地区（阿巴拉契亚的山区和东部平原 北卡罗来纳州）。这些县在美国的吸烟率最高 测试（标准）实施计划与新颖的增强程序。标准程序使用 基于证据的外部设施 - 为EMS服务提供培训和技术支持，以支持 整合增强的烟草控制措施（包括建议和推荐吸烟的人 尚未准备好接受MHealth辅助人口健康干预措施。小说增强了 实施计划将包括标准计划A EMS冠军计划。 EMS目前 烟将自己参加标签。那些参加的人，冠军，然后将使用他们的 标签经验以支持实施作为内部促进者。他们将鼓励其他EMS体验 选项卡，纵向鼓励在所有EMS的常规工作流程中使用烟草控制实践，将是 能够利用他们在标签上的个人经验与吸烟的患者进行更丰富的对话。使用这些 策略，我们试图与生活在难以及的农村地区生活的个人吸引，而获得临床服务的机会较少。 通过短暂，低强度，可口的干预措施，可以使这些人与这些人保持联系 并促进技能建设以支持未来的戒酒。 TAB干预解决了 使用新颖的格式（一种短暂的节制游戏）与使用MHealth支持的简短节制游戏一起吸引低熟的个体 并在研究10年的基础上进行。我们最近在JAMA内部发表了第一个TAB效力试验 药品。此初步数据支持当前应用程序，不包括大量 居住在粗糙地区的个人。在这个项目中，我们将随机对标签与设计的主动比较 隔离标签的效果并在两组之间平衡参与者的接触。除了评估 实施成功和有效性结果，我们将研究停止途径。告知 维持和传播，我们将收集有关实施忠诚，县级改编的数据， 转诊和患者级别的参与度的变化以及EMS和患者级别的变化。到 评估预算影响，我们将跟踪实施策略和干预的成本。