ASPO Abstracts
A scoping review of tobacco treatment implementation research in the Veterans Health Administration
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose: Tobacco use remains the leading cause of preventable cancer. Veterans consistently use tobacco at
higher rates than the general population. Despite efforts to increase tobacco cessation among veterans, gaps
remain in adherence to clinical practice guidelines in the Veterans Health Administration (VHA). Tobacco treatment
implementation research seeks to fill this gap by promoting the uptake of evidence-based interventions into routine
clinical practice. The aim of this scoping review was to summarize tobacco treatment implementation research in
the VHA.
Methods: We conducted a systematic search of PubMed, PsycInfo, and CINAHL databases for articles published
prior to March 2019. Articles were included if they reported on VHA tobacco treatment interventions and evaluated
at least one implementation outcome. Included articles were coded according to the PICO framework,
implementation strategies used, and implementation outcomes measured. Barriers and facilitators to
implementation were also assessed. Implementation strategies were categorized by Waltz’s mapping of the Expert
Recommendations for Implementing Change and outcomes were classified according to Proctor’s framework for
implementation outcomes.
Results: We identified 23 articles reporting on 19 studies. Study settings included inpatient units (n=4), PTSD
clinics (n=4), and primary care (n=3). Common strategies were training and educating stakeholders (n=10), use of
iterative strategies (n=10), and changes to infrastructure (n=8). Fidelity (n=12) and reach (n=9) were the most
frequently reported implementation outcomes. Perceived implementation facilitators included intervention
characteristics (e.g. complexity level), use of tools (e.g. EHR templates), and staff training. Common barriers were
competing priorities, lack of resources, and perceived patient disinterest in cessation.
Conclusions: This review highlights the various tobacco treatment implementation strategies used in the VHA,
along with common implementation challenges. Further understanding of these factors can enhance tobacco
treatment and reduce cancer burden in the VHA.
Keywords: tobacco cessation, veterans, implementation science