Table 2.

Challenges and implications for sustainability and disseminability of the intervention.

Challenges faced	Implications and improvements
The previsit screener identifies parents who smoke and offers them treatment but does not sign them up	The previsit screener could go a step further and automatically connect parents who smoke with resources to help them quit smoking to further reduce any burden on practice staff
The previsit screener was not integrated with other screeners and paper work leaving the front desk juggling multiple previsit tasks in different platforms at check-in	Integrate the previsit tobacco use screener with other previsit surveys in a single platform that would all populate the appropriate sections of the child's medical record
The previsit screener was offered too frequently	The previsit screener should screen all families once a year for tobacco use, following up with only those families that have a smoker at scheduled time intervals
Billing for services is a good financial incentive for the clinicians and practices but did not happen routinely	Billing for tobacco use counselling should be easy and automated in the child's medical record