Table 2.
Implementation strategies, adaptations, and justification
| Implementation strategy | Adaptation | Justification |
|---|---|---|
| Training and clinical decision support (CDS: i.e., coaching guide) |
▪ Adapted training for HCPs to facilitate discussions about HIV referent themes during advice and brief counseling. ▪ Adapted training to address specific theory-driven barriers to quitting among PLWH and health impact of smoking among this population and reinforce treatment of waterpipe use. ▪ Adapted a 1-page coaching guide, from the NYC Department of Health to include adapted content from the training to guide the delivery of the 3As during the patient visit. |
▪ Dual use of cigarettes and waterpipe use was common. ▪ Coaching guide reinforce training among HCPs with no previous experience delivering TDT and increase self-efficacy motivation and fidelity to 3As+R. |
| Workflow mapping and redesign |
▪ Revised roles and responsibilities to align with a new workflow for each intervention component. ○ 3As. ○ Referral to onsite nurse counselor. ○ Quitline referral. ○ Dispensing NRT onsite. |
▪ Increase collective efficacy and promote team care principles: shared goals, defined roles, and responsibilities. ▪ Increase compatibility with routine care and registration process. ▪ Reduce complexity. |
| ▪ OPCs include onsite pharmacies creating an opportunity to normalize the process for offering NRT during patient visits. | ||
| Referral system | In partnership with Quitline and staff, changed the standard Vietnam Quitline referral system from reactive to proactive approach: once a referral is received, Quitline initiates calls to patients to engage in counseling. |
▪ Studies indicate that a reactive approach is less effective than a proactive approach in reaching patients [20]. ▪ Patients and providers confirmed less likely to connect if required to call. ▪ The referral to Quitline created a standard care approach for delegating more intensive counseling to a sustainable resource. Patients were not concerned about confidentiality issues related to Quitline referrals. |
| TDT documentation and NRT tracking system | Created paper-based screening and TDT documentation system. | Enhance fidelity to the new workflow. |