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- Title
Enablers and Inhibitors to Implementing Tobacco Cessation Interventions within Homeless-Serving Agencies: A Qualitative Analysis of Program Partners' Experiences.
- Authors
Martinez Leal, Isabel; Siddiqi, Ammar D.; Rogova, Anastasia; Britton, Maggie; Chen, Tzuan A.; Williams, Teresa; Casey, Kathleen; Sanchez, Hector; Reitzel, Lorraine R.
- Abstract
Simple Summary: People experiencing homelessness are at increased risk of dying from tobacco-related cancers due to their elevated tobacco use rates but are not offered evidence-based tobacco dependence interventions by homeless-serving agencies within the United States. Through pre- and post-implementation provider interviews, this qualitative study explored the factors enabling and inhibiting organizational readiness to implement a comprehensive tobacco-cessation intervention within three homeless-serving agencies. Although the organizational readiness was initially high, at the post-implementation, changing contextual factors, primarily resource privations, undermined the provider change efficacy and limited the program implementation. These findings support the value and acceptability of implementing tobacco-cessation interventions within homeless-serving agencies, and they identify the factors needed to build organizational capacity for successful implementation. Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n = 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers' attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study's findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation.
- Subjects
TEXAS; SMOKING cessation; HUMAN services programs; PROFESSIONAL practice; NICOTINE replacement therapy; QUALITATIVE research; RESEARCH funding; EXECUTIVES; RISK-taking behavior; WORK environment; SMOKING; INTERVIEWING; EVALUATION of human services programs; CONTENT analysis; DECISION making; PRE-tests &; post-tests; ASSOCIATIONS, institutions, etc.; ORGANIZATIONAL change; ATTITUDES of medical personnel; EVIDENCE-based medicine; CHANGE theory; RESOURCE-limited settings; TUMORS; MANAGEMENT
- Publication
Cancers, 2024, Vol 16, Issue 11, p2162
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16112162