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. 2019 Oct 4;7(10):e14331.
doi: 10.2196/14331.

Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study

Amanda C Blok  1   2 , Rajani S Sadasivam  3 , Timothy P Hogan  3   4 , Angela Patterson  3 , Nicole Day  5 , Thomas K Houston  6
Affiliations

Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study

Amanda C Blok et al. JMIR Mhealth Uhealth. .

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, tobacco use cessation; mobile health; patient transfer; smoking; smoking cessation; telemedicine; tobacco.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Reach of the Technology Inpatient Program for Smokers intervention by week and phase.
Figure 3
Figure 3
Reach of the Technology Inpatient Program for Smokers intervention by unit and phase. Analysis included only participants who reported location (N=41). Missing responses due to no response (N=57), smokers not on a hospital unit (N=3), and smokers who were unsure what unit they were on (N=2) are assumed to be at random. Mean new smokers signed up for all units over all phases is 2.6 smokers, represented by a dashed line.
See this image and copyright information in PMC

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