Addressing Tobacco Use in Underserved Communities Outside of Primary Care: The Need to Tailor Tobacco Cessation Training for Community Health Workers
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Published:2023-04-19
Issue:8
Volume:20
Page:5574
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ISSN:1660-4601
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Container-title:International Journal of Environmental Research and Public Health
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language:en
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Short-container-title:IJERPH
Author:
Tan Marcia M.12ORCID, Oke Shariwa1, Ellison Daryn1, Huard Clarissa1, Veluz-Wilkins Anna12
Affiliation:
1. Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA 2. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611, USA
Abstract
Individuals from communities with a low socioeconomic status have the highest rates of tobacco use but are less likely to receive assistance with quitting. Community health workers (CHWs) are well-positioned to engage these communities; however, CHWs face barriers in receiving relevant tobacco cessation training. The objective of this study was to conduct a mixed methods needs assessment to describe tobacco practices and the desire for training among CHWs. After incorporating CHW feedback, we developed a needs assessment survey to understand knowledge, practices, and attitudes about tobacco cessation in Chicago, IL. CHWs (N = 23) recruited from local community-based organizations completed the survey online or in-person. We then conducted a focus group with CHWs (N = 6) to expand upon the survey and used the Framework Method to analyze the qualitative data. CHWs reported that their clients had low incomes, low literacy levels, and high smoking rates (e.g., “99%” of patients). About 73.3% reported discussing tobacco use during visits, but fewer reported that they had provided cessation advice (43%) or intervened directly (9%). CHWs described high variability in their work environments (e.g., location, duration, content of visits, etc.) and greater continuity of care. CHWs discussed that existing training on how to conduct tobacco interventions is ineffective, because of its stand-alone design. Our findings illustrate how CHWs adapt to their clients’ needs, and that the currently available “gold-standard” cessation curricula are incompatible with the training needs and flexible care delivery model of CHWs. A curriculum tailored to the CHW experience is needed to maximize the strengths of the CHW care model by training CHWs to adaptively intervene regarding tobacco use in their highly burdened patients.
Funder
National Institutes of Health Ruth L Kirschstein Postdoctoral Fellowship ACS_IRG American Cancer Society and the UChicago Cancer Center Support Grant
Subject
Health, Toxicology and Mutagenesis,Public Health, Environmental and Occupational Health
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