Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Oct 18;13(4):e87.
doi: 10.2196/jmir.1721.

Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation

Rajani S Sadasivam  1 , Kathryn Delaughter, Katie Crenshaw, Heather J Sobko, Jessica H Williams, Heather L Coley, Midge N Ray, Daniel E Ford, Jeroan J Allison, Thomas K Houston
Affiliations
Randomized Controlled Trial

Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation

Rajani S Sadasivam et al. J Med Internet Res. .

Abstract

Background: Patient self-management interventions for smoking cessation are effective but underused. Health care providers do not routinely refer smokers to these interventions.

Objective: The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care.

Methods: We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings.

Results: Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider-patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer).

Conclusions: Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial.

Trial: Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy).

PubMed Disclaimer

Conflict of interest statement

None declared

Figures

Figure 1
Figure 1
Development stages of ReferASmoker.org (RCT = randomized controlled trial).
Figure 2
Figure 2
ReferASmoker.org Web-based system home page.
Figure 3
Figure 3
Sample ReferASmoker.org Web-based system practice report.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention (CDC) Cigarette smoking among adults--United States, 2000. MMWR Morb Mortal Wkly Rep. 2002 Jul 26;51(29):642–5. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5129a3.htm - PubMed
    1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997 May 24;349(9064):1498–504. doi: 10.1016/S0140-6736(96)07492-2.S0140-6736(96)07492-2 - DOI - PubMed
    1. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003 Jul 2;290(1):86–97. doi: 10.1001/jama.290.1.86. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12837716290/1/86 - DOI - PubMed
    1. Fiore MC, Croyle RT, Curry SJ, Cutler CM, Davis RM, Gordon C, Healton C, Koh HK, Orleans CT, Richling D, Satcher D, Seffrin J, Williams C, Williams LN, Keller PA, Baker TB. Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation. Am J Public Health. 2004 Feb;94(2):205–10. http://www.ajph.org/cgi/pmidlookup?view=long&pmid=14759928 - PMC - PubMed
    1. Fiore M. Treating Tobacco Use and Dependence: 2008 Update (Clinical Practice Guideline) Rockville, MD: Department of Health and Human Services, Public Health Service; 2008.

Publication types

MeSH terms

Associated data