Multi-level barriers and facilitators to implementing tobacco screening and cessation counseling in a Federally Qualified Health Center.

backgroundDespite persistent tobacco control efforts, the prevalence of smoking, especially among low-income populations, remains high. The prevalence of tobacco use among the primarily low-income populations served by Federally Qualified Health Centers (FQHCs), is approximately 5 percentage points higher than the national average. Evidence based interventions such as clinician delivered tobacco cessation counseling are brief and effective, however, providers are often faced with various barriers that impede their ability to offer tobacco related counseling consistently. The purpose of this study was to understand multilevel and multi-perspective barriers and facilitators to implementing tobacco screening and cessation counseling at a large, multi-site FQHC.

methodsThis study used a descriptive qualitative design. Semi-structured interviews were conducted among a diverse group of FQHC staff including providers, clinical staff (e.g., nurse, medical assistant), clinic site managers, and administrators. Interviews were guided by the Practical, Robust Implementation and Sustainability Model (PRISM), lasting an average of 35 min. Data analysis included descriptive statistics to summarize participant characteristics and applied thematic analysis to identify themes related to barriers and facilitators in implementing tobacco screening and cessation counseling.

resultsSixteen FQHC staff participated in the study. Participants were between the ages of 31-69 years old (M = 47.6, SD = 11.2) and had 4-45 years of medical experience (Median = 17.25). Participants represented various roles within the FQHC with 8 Providers, 5 Administrators, and 1 Registered Nurse, Care Coordinator, and Medical Assistant each. Key themes were identified across PRISM contextual domains, including provider knowledge gaps and time constraints, patients' motivation to quit and hesitation to disclose tobacco use, as well as external referral challenges. Prioritizing tobacco cessation alongside other important health conditions, coupled with rapport building and involving dedicated support staff in tobacco cessation efforts, were perceived to be key strategies to increase consistent delivery of tobacco cessation services.

conclusionThis study sheds light on the multifaceted barriers and facilitators to implementing tobacco cessation services within a large multi-site FQHC. By addressing these key determinants, FQHCs can further enhance ongoing efforts to reduce tobacco use among low-income communities and improve patients' overall health. TITLE REGISTRATION: Not applicable.