Nurse-driven mHealth implementation using the Technology Inpatient Program for smokers (TIPs): Mixed methods study

Amanda C. Blok, Rajani S. Sadasivam, Timothy P. Hogan, Angela Patterson, Nicole Day, Thomas K. Houston

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere14331
JournalJournal of medical Internet research
Volume21
Issue number10
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Posters
Telemedicine
Inpatients
Nurses
Technology
Maintenance
Costs and Cost Analysis
Patient Transfer
Hospital Units
Process Assessment (Health Care)
Smoking Cessation
Cause of Death
Smoking

Keywords

  • Care transition
  • Implementation strategy
  • MHealth, tobacco use cessation
  • Mobile health
  • Patient transfer
  • Smoking
  • Smoking cessation
  • Telemedicine
  • Tobacco

ASJC Scopus subject areas

  • Health Informatics

Cite this

Nurse-driven mHealth implementation using the Technology Inpatient Program for smokers (TIPs) : Mixed methods study. / Blok, Amanda C.; Sadasivam, Rajani S.; Hogan, Timothy P.; Patterson, Angela; Day, Nicole; Houston, Thomas K.

In: Journal of medical Internet research, Vol. 21, No. 10, e14331, 01.01.2019.

Research output: Contribution to journalArticle

Blok, Amanda C. ; Sadasivam, Rajani S. ; Hogan, Timothy P. ; Patterson, Angela ; Day, Nicole ; Houston, Thomas K. / Nurse-driven mHealth implementation using the Technology Inpatient Program for smokers (TIPs) : Mixed methods study. In: Journal of medical Internet research. 2019 ; Vol. 21, No. 10.
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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.",
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