RECRUITINGINTERVENTIONAL

Reach Through Equitable Implementation in Utah

Reach Through Equitable Implementation in Utah (REI-UT)

About This Trial

The goal of this pragmatic, multilevel Type III Hybrid Effectiveness-Implementation trial is to increase the reach of existing evidence-based interventions (EBIs) for tobacco cessation and to mitigate the impact of adverse Social Drivers of Health (SDOH) among safety-net healthcare system patients who live in persistent poverty (PP) census tracts. Aim 1: Test the ability of patient-level Conversational Agents (CA) \& Patient Navigation (PN) dissemination strategies to increase the Reach (primary outcome) of evidence-based tobacco cessation treatment delivered via the Utah Tobacco and Nicotine Quit Services (Quit Services) among Community Health Center (CHC) patients who use tobacco and live in persistent poverty census tracts. Secondary analyses will examine the outcome of Reach of services for SDOH among these patients and will evaluate both 1) patient-level CA and PN dissemination strategies and 2) a clinic-level implementation strategy using a pre-post design. Aim 2: Explore contextual factors (e.g., clinic size, patient composition, rurality, patient demographics) related to the Reach, Adoption, Implementation, and potential Maintenance of strategies. Aim 3: Determine the cost-effectiveness of clinic and patient-level strategies based on Quit Services enrollment and service receipt for SDOH. This trial implements a clinic-level implementation strategy, Ask-Advise-Connect (AAC), to address tobacco cessation and needs around social drivers of health for patients in all participating clinics. Eligible patients who are not enrolled in Quit Services four weeks after the clinical encounter, will receive text messages from a chatbot offering information and connections to the Quit Services and patient navigation support from a Community Health Worker.

Who May Be Eligible (Plain English)

Who May Qualify: - ≥ 18 years of age - Speak English or Spanish - Currently use tobacco - Live in a persistent poverty census tract - Present at participating clinics - Valid cell phone number in the electronic health record (EHR) - Electronic health records indicate they have not opted out of receiving text contact from the clinic Who Should NOT Join This Trial: - Opt-out of study Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language

Inclusion Criteria: * ≥ 18 years of age * Speak English or Spanish * Currently use tobacco * Live in a persistent poverty census tract * Present at participating clinics * Valid cell phone number in the electronic health record (EHR) * Electronic health records indicate they have not opted out of receiving text contact from the clinic Exclusion Criteria: * Opt-out of study

Treatments Being Tested

BEHAVIORAL

Clinic Level: AAC - SDOH, AAC - Tobacco

Ask-Advise-Connect (AAC) is a health information technology (HIT) implementation strategy that consists of EHR-based point-of-care supports for the assessment of tobacco use and Social Drivers of Health (SDOH).

BEHAVIORAL

Non-Bundled

All patient level strategies will address only the content of increasing reach of the Utah Tobacco Quit Services.

BEHAVIORAL

Bundled

All patient level strategies will address the content of increasing reach of the Utah Tobacco Quit Services and SDOH.

BEHAVIORAL

Dose 1

The number of proactive outreach opportunities for CA the patient receives. Patient will receive 1 opportunity for CA, over 12 months following a patient's initial clinic visit, that includes a simple one-touch response to directly connect to the Quit Services or the CHW.

BEHAVIORAL

Dose 3

The number of proactive outreach opportunities for CA the patient receives. Patient will receive 3 opportunities for CA, over 12 months following a patient's initial clinic visit, that includes a simple one-touch response to directly connect to the Quit Services or the CHW.

BEHAVIORAL

Dose 6

The number of proactive outreach opportunities for CA the patient receives. Patient will receive 6 opportunities for CA, over 12 months following a patient's initial clinic visit, that includes a simple one-touch response to directly connect to the Quit Services or the CHW.

BEHAVIORAL

Dose 9

The number of proactive outreach opportunities for CA the patient receives. Patient will receive 9 opportunities for CA, over 12 months following a patient's initial clinic visit, that includes a simple one-touch response to directly connect to the Quit Services or the CHW.

BEHAVIORAL

Dose 12

The number of proactive outreach opportunities for CA the patient receives. Patient will receive 12 opportunities for CA, over 12 months following a patient's initial clinic visit, that includes a simple one-touch response to directly connect to the Quit Services or the CHW.

BEHAVIORAL

RPN

Reactive Patient Navigation Only (RPN): Patient can request to speak to a CHW, over 12 months following a patient's initial clinic visit, at any time.

BEHAVIORAL

PPN

Proactive Patient Navigation (PPN): Patient is proactively called, over 12 months following a patient's initial clinic visit, by a CHW up to 4 times.

Locations (1)

Huntsman Cancer Institute at the University of Utah

Salt Lake City, Utah, United States