Co-designing Behavior Change Resources With Treatment-Seeking Smokers: Engagement Events' Findings

Minian, Nadia; Lingam, M. Shankar; deRuiter, Wayne K.; Dragonetti, Rosa; Selby, Peter

doi:10.3389/fpubh.2021.555449

Cited by 3 publications

(1 citation statement)

References 55 publications

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“…In this study, the health care practitioners at the primary clinics acted as the delivery system. The ISF’s synthesis and translation systems were addressed by engaging STOP program participants in the cocreation of health behavior change messages and a self-monitoring resource for tracking their health behaviors [ 42 ]. As part of the ISF support system, we provided health care practitioners with training (via an interactive webinar [ 43 ]) around evidence-based recommendations for addressing physical activity and fruit and vegetable consumption as part of a smoking cessation treatment program [ 44 ].…”

Section: Methodsmentioning

confidence: 99%

The Impact of a Clinical Decision Support System for Addressing Physical Activity and Healthy Eating During Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial

Minian¹,

Lingam²,

Moineddin³

et al. 2022

J Med Internet Res

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Background People who smoke have other risk factors for chronic diseases, such as low levels of physical activity and poor diet. Clinical decision support systems (CDSSs) might help health care practitioners integrate interventions for diet and physical activity into their smoking cessation programming but could worsen quit rates. Objective The aims of this study are to assess the effects of the addition of a CDSS for physical activity and diet on smoking cessation outcomes and to assess the implementation of the study. Methods We conducted a pragmatic hybrid type I effectiveness-implementation trial with 232 team-based primary care practices in Ontario, Canada, from November 2019 to May 2021. We used a 2-arm randomized controlled trial comparing a CDSS addressing physical activity and diet to treatment as usual and used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to measure implementation outcomes. The primary outcome was self-reported 7-day tobacco abstinence at 6 months. Results We enrolled 5331 participants in the study. Of these, 2732 (51.2%) were randomized to the intervention group and 2599 (48.8%) to the control group. At the 6-month follow-up, 29.7% (634/2137) of respondents in the intervention arm and 27.3% (552/2020) in the control arm reported abstinence from tobacco. After multiple imputation, the absolute group difference was 2.1% (95% CI −0.5 to 4.6; F1,1000.42=2.43; P=.12). Mean exercise minutes changed from 32 (SD 44.7) to 110 (SD 196.1) in the intervention arm and from 32 (SD 45.1) to 113 (SD 195.1) in the control arm (group effect: B=−3.7 minutes; 95% CI −17.8 to 10.4; P=.61). Servings of fruit and vegetables changed from 2.64 servings to 2.42 servings in the intervention group and from 2.52 servings to 2.45 servings in the control group (incidence rate ratio for intervention group=0.98; 95% CI 0.93-1.02; P=.35). Conclusions A CDSS for physical activity and diet may be added to a smoking cessation program without affecting the outcomes. Further research is needed to improve the impact of integrated health promotion interventions in primary care smoking cessation programs. Trial Registration ClinicalTrials.gov NCT04223336 https://www.clinicaltrials.gov/ct2/show/NCT04223336 International Registered Report Identifier (IRRID) RR2-10.2196/19157

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Section: Methodsmentioning

confidence: 99%

The Impact of a Clinical Decision Support System for Addressing Physical Activity and Healthy Eating During Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial

Minian¹,

Lingam²,

Moineddin³

et al. 2022

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

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Healthcare providers’ perspectives on implementing a brief physical activity and diet intervention within a primary care smoking cessation program: a qualitative study

Minian,

Mehra,

Lingam

et al. 2024

BMC Prim. Care

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Background Post-smoking-cessation weight gain can be a major barrier to quitting smoking; however, adding behavior change interventions for physical activity (PA) and diet may adversely affect smoking cessation outcomes. The “Picking up the PACE (Promoting and Accelerating Change through Empowerment)” study assessed change in PA, fruit/vegetable consumption, and smoking cessation by providing a clinical decision support system for healthcare providers to utilize at the intake appointment, and found no significant change in PA, fruits/vegetable consumption, or smoking cessation. The objective of this qualitative study was to explore the factors affecting the implementation of the intervention and contextualize the quantitative results. Methods Twenty-five semi-structured interviews were conducted with healthcare providers, using questions based on the National Implementation Research Network’s Hexagon Tool. The data were analyzed using the framework’s standard analysis approach. Results Most healthcare providers reported a need to address PA and fruit/vegetable consumption in patients trying to quit smoking, and several acknowledged that the intervention was a good fit since exercise and diet could improve smoking cessation outcomes. However, many healthcare providers mentioned the need to explain the fit to the patients. Social determinants of health (e.g., low income, food insecurity) were brought up as barriers to the implementation of the intervention by a majority of healthcare providers. Most healthcare providers recognized training as a facilitator to the implementation, but time was mentioned as a barrier by many of healthcare providers. Majority of healthcare providers mentioned allied health professionals (e.g., dieticians, physiotherapists) supported the implementation of the PACE intervention. However, most healthcare providers reported a need for individualized approach and adaptation of the intervention based on the patients’ needs when implementing the intervention. The COVID-19 pandemic was found to impact the implementation of the PACE intervention based on the Hexagon Tool indicators. Conclusion There appears to be a need to utilize a flexible approach when addressing PA and fruit/vegetable consumption within a smoking cessation program, based on the context of clinic, the patients’ it is serving, and their life circumstances. Healthcare providers need support and external resources to implement this particular intervention. Name of the registry Clinicaltrials.gov. Trial registration number NCT04223336. Date of registration 7 January 2020 Retrospectively registered. URL of trial registry record https://classic.clinicaltrials.gov/ct2/show/NCT04223336.

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Impact of a Cloud-based Clinical Decision Support System for Addressing Physical Activity and/or Healthy Eating during Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial (Preprint)

Minian¹,

Lingam²,

Moineddin³

et al. 2022

Preprint

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BACKGROUND People who smoke also have other risk factors for chronic disease such as sedentary behaviours and poor diet. Usual practice is to address smoking with the exclusion of these other behaviours. Clinical decision support systems (CDSS) are a promising resource to effectively support health care practitioners integrate interventions for diet and physical activity as part of their smoking cessation programming. OBJECTIVE The aims of this study are to: (1) assess whether adding a CDSS for physical activity and diet to a smoking cessation program affects smoking cessation outcomes, and (2) assess the implementation of the study. METHODS We conducted a pragmatic, hybrid type I effectiveness/implementation trial with 232 team-based primary care practices in Ontario Canada from November 2019 to May 2021. We measured the effectiveness of the CDSS using a two-arm randomized control trial comparing a CDSS for addressing physical activity and diet as part of a smoking cessation program with treatment as usual, and used the RE-AIM Framework to measure implementation outcomes. RESULTS In total, 5331 smokers did not meet the recommended Canadian guidelines for physical activity and/or fruit/vegetable consumption were enrolled in this study). We randomized 2599 people to the control group and 2732 to the intervention group. At the six month follow-up, 552 of 2020 respondents (27.3%) in the control arm and 634 of 2137 respondents (29.7%) in the intervention arm reported abstinence from tobacco. After multiple imputation, these proportions were 25.9% (95% CI = 24.2%, 27.6%) and 28.0% (95% CI = 26.1%, 29.8%), respectively, corresponding to an absolute group difference of 2.1% (95% CI = -0.5%, 4.6%). This difference did not meet our threshold for significance (F(1, 1000.42)=2.43, p=0.12). From baseline to six month follow-up, mean exercise minutes changed from 32 to 113 in the control arm and from 32 to 110 in the intervention arm (group effect: B = -3.7 minutes, 95% CI = -17.8, 10.4, p=0.61). For servings of fruit and vegetables, group means changed from 2.52 at baseline to 2.45 at six month in the control group and from 2.64 to 2.42 in the intervention group (incidence rate ratio for intervention group = 0.98, 95% CI = 0.93, 1.02, p=0.35). CONCLUSIONS Our study findings illustrate that the introduction of a CDSS that guides health care practitioners to address multiple health behaviours among their patients did not negatively affect smoking cessation outcomes and did not have a significant impact on participants’ physical activity nor fruit/vegetable consumption. Although there are still challenges that need to be addressed, thoughtful implementation of CDSS could transform the smoking cessation program into a more holistic program in primary care. CLINICALTRIAL ClinicalTrials.gov (NCT04223336). https://clinicaltrials.gov/ct2/show/NCT04223336 INTERNATIONAL REGISTERED REPORT RR2-10.2196/19157

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Co-designing Behavior Change Resources With Treatment-Seeking Smokers: Engagement Events' Findings

Cited by 3 publications

References 55 publications

The Impact of a Clinical Decision Support System for Addressing Physical Activity and Healthy Eating During Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial

The Impact of a Clinical Decision Support System for Addressing Physical Activity and Healthy Eating During Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial

Healthcare providers’ perspectives on implementing a brief physical activity and diet intervention within a primary care smoking cessation program: a qualitative study

Impact of a Cloud-based Clinical Decision Support System for Addressing Physical Activity and/or Healthy Eating during Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial (Preprint)

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