Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n= 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers’ attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study’s findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation.
尽管美国无家可归人群中烟草使用率极高（约80%），且烟草相关癌症已成为该群体的第二大死因，但服务于无家可归者的机构却很少为他们提供烟草使用治疗。本研究通过质性研究方法，探讨了在无家可归者服务机构中实施循证性无烟工作场所计划的促进因素与阻碍因素。该计划涵盖无烟政策采纳、针对烟草使用的专业服务人员培训以及尼古丁替代疗法。研究通过对机构服务人员及管理者（共13人）开展实施前与实施后访谈，分别探讨了如何使干预措施适应具体机构需求，并评估了项目成效。数据分析以组织变革准备理论为框架，归纳出三个核心维度：变革承诺、变革效能及情境因素。研究发现，从实施前到实施后，日益增加的挑战影响了组织能力与服务人员态度，使得原先的促进因素被重新解读为阻碍因素，最终导致即使在资源供给的情况下，项目落实程度依然有限。这些结果表明，资源匮乏的无家可归者服务机构需要更多支持与指导，以克服基础设施障碍，并建立实施无烟工作场所计划所需的能力。本研究结果可为未来无烟工作场所计划干预提供指导，有助于识别具备实施条件的机构，并通过能力建设确保其成功参与项目。
肿瘤(癌症)患者之家