Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n= 34) and managers (n= 12) and 4 with patients (n= 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake.
背景：农村地区烟草使用率异常偏高，导致癌症死亡率升高，但由于医疗资源有限、贫困率高、未参保率高以及共患物质使用障碍（SUDs）等因素，该问题常未得到有效干预。本研究探讨了运用快速定性分析（RQA）指导德克萨斯州医疗服务不足地区为SUDs成人患者提供服务的医疗中心调整无烟工作场所计划（TFWP）的可行性。方法：2023年9月至12月及2024年5月至7月期间，我们在6家医疗中心开展了11次实施前的虚拟半结构化小组访谈（总人数N=69），重点探讨TFWP的本土化适配，其中7次访谈对象为医疗服务提供者（n=34）和管理人员（n=12），4次访谈对象为患者（n=23）。两名专业分析师使用基于访谈提纲关键领域设计的RQA模板，独立总结访谈转录文本，通过矩阵法系统化整理数据以实现对比分析。结果：研究识别出两大核心主题——机构戒烟支持与实践的缺失及态度性障碍，具体表现为：（1）需要针对当地人群定制项目材料；（2）现有戒烟实践有限且政策不完善——工作人员要求加强烟草筛查与戒烟干预指导，并整合新型干预措施；（3）对烟草治疗存在矛盾认知可能阻碍实施（例如有戒烟意愿却担忧戒烟会导致SUDs复发）；（4）环境支持不足——工作人员需要烟草使用干预培训，患者需要团体戒烟咨询；双方均提出需要尼古丁替代疗法支持。结论：通过参与者对以下调整措施的接受意愿，RQA识别出需重点发展的能力建设领域：项目内容（如培训与定制教育材料）、实施方法/系统（如采用补充性烟草护理干预措施）及实施策略（如将戒烟实践纳入常规诊疗），这些对优化TFWP的适配性与实施效果至关重要。本研究结果可为及时的形成性评估提供依据，通过解决特定场所的需求与实施障碍，指导类似干预措施的设计与定制，从而提升项目采纳度。
肿瘤(癌症)患者之家