@article{e9b1fe0d7ebd4e98a8fe655a3fb89644,
title = "Nurse-driven mHealth implementation using the Technology Inpatient Program for smokers (TIPs): Mixed methods study",
abstract = "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.",
keywords = "Care transition, Implementation strategy, MHealth, Mobile health, Patient transfer, Smoking, Smoking cessation, Telemedicine, Tobacco, tobacco use cessation",
author = "Blok, {Amanda C.} and Sadasivam, {Rajani S.} and Hogan, {Timothy P.} and Angela Patterson and Nicole Day and Houston, {Thomas K.}",
note = "Funding Information: 1Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, United States 2Systems, Populations and Leadership Department, School of Nursing, University of Michigan, Ann Arbor, MI, United States 3Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States 4Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Medical Center, United States Department of Veterans Affairs, Bedford, MA, United States 5University of Massachusetts Memorial Health Center, Worcester, MA, United States 6Learning Health Systems, Department of Medicine, Wake Forest University, Winston-Salem, NC, United States Funding Information: We would like to thank the nurses who gave of their time and expertise to inform and evaluate the program. The work you do every day is inspiring. Funding for the study was received from the National Cancer Institute (R01 CA190866-01A1) and the University of Massachusetts Medical School?s Center for Clinical and Translational Science (1UL1RR031982-01 U54). ACB is supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research, the VA Center for Healthcare Organizational and Implementation Research, the VA Center for Clinical Management Research, and the University of Massachusetts Medical School?s Prevention and Control of Cancer: Post-doctoral Training in Implementation Science Program (1R25CA172009-02). RSS is funded by a National Cancer Institute Career Development Award (K07 CA172677). Funding Information: We would like to thank the nurses who gave of their time and expertise to inform and evaluate the program. The work you do every day is inspiring. Funding for the study was received from the National Cancer Institute (R01 CA190866-01A1) and the University of Massachusetts Medical School{\textquoteright}s Center for Clinical and Translational Science (1UL1RR031982-01 U54). ACB is supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research, the VA Center for Healthcare Organizational and Implementation Research, the VA Center for Clinical Management Research, and the University of Massachusetts Medical School{\textquoteright}s Prevention and Control of Cancer: Post-doctoral Training in Implementation Science Program (1R25CA172009-02). RSS is funded by a National Cancer Institute Career Development Award (K07 CA172677). Publisher Copyright: {\textcopyright}Amanda C Blok, Rajani S Sadasivam, Timothy P Hogan, Angela Patterson, Nicole Day, Thomas K Houston.",
year = "2019",
doi = "10.2196/14331",
language = "English (US)",
volume = "7",
journal = "JMIR mHealth and uHealth",
issn = "2291-5222",
publisher = "Journal of medical Internet Research",
number = "10",
}