Surmounting Obstacles to Smoking Prevention: Barriers to Smoking Cessation Counseling at a Community-based Health Center in Connecticut

Background: Cigarette smoking is currently a leading cause of morbidity and mortality in the United States and throughout the world. Smoking cessation has emerged as an important preventative avenue for reducing the population-level attributable risk of cardiovascular, pulmonary, and oncologic disease due to cigarette smoking. Despite the health benefits of abstinence, durable smoking cessation is achieved by only a fraction of current smokers. As potential agents of change, healthcare providers possess the ability to promote smoking cessation through both counseling and pharmacotherapy. Consequently, the purpose of this investigation was to assess the challenges and limitations encountered by the Smoking Cessation Counseling Service at Optimus Health Care, the largest community-based health center in a low income area of Connecticut. Methods: Following a literature review of current best practices for smoking cessation in the clinical setting, this study utilized an interview and survey tool to identify the primary barriers to smoking cessation counseling in partnership with the healthcare providers at Optimus Health Care. Results: Preliminary demographic data indicated that approximately 88% of the smoking patients at Optimus Health Care have received smoking cessation counseling in the last 12 months. The main barriers assessed in this study included time with patients, patient motivation, access to cessation interventions, and patient comorbidities. Through a series of 14 healthcare provider interviews and 13 survey questionnaires throughout the locations of Optimus Health Care, this study illuminated the lack of time in clinician schedule, patient’s preparedness to quit, and competing patient comorbidities as the primary barriers to providing smoking cessation counseling. Conclusions: Understanding the barriers to smoking cessation counseling faced by healthcare providers in the community setting remains an important objective for disease prevention and public health. This study identified the main barriers cited by clinicians in the community setting towards providing smoking cessation and generates recommendations for community-based healthcare providers regarding surmounting barriers to smoking cessation counseling.https://elischolar.library.yale.edu/ysph_pbchrr/1039/thumbnail.jp

Providing Culturally Competent Care in the Face of Health Disparities: Assessment and Training Recommendations

Background: Community health centers are a critical source of care for populations who disproportionally experience health disparities, including the uninsured and underinsured, racial and ethnic minorities, and patients with a preferred language other than English. Optimus Health Care (Optimus) is the second largest health center in Connecticut, with clinics located in Bridgeport and Stamford. Cultural competency, or a set of behaviors, attitudes, and policies that enable professionals to work effectively in cross-cultural situations holds immense potential for improving patient-physician communication and for providing effective service delivery. Objectives: This study sought to (1) better understand the barriers to care faced among patients at Optimus (2) assess staff knowledge, attitudes, and skills regarding cultural competency to make recommendations regarding future cultural competency staff trainings. Methods: Electronic medical records (EMR) of patients seen at Optimus between January 2012 and March 2013 who had a diagnosis of hyperlipidemia, hypertension, and/or diabetes were analyzed to describe characteristics related to insurance status, race/ethnicity, primary language, age, gender, and clinic location. A web-based survey was developed based on the Cultural Competence Self-Assessment Questionnaire (CCSAQ) and distributed electronically to Optimus staff. Survey results were analyzed to compare responses according to staff position type and themes were examined among respondent assessments of the current cultural competency trainings provided by Optimus. Results: The majority of patients included in the EMR analysis receive Medicare or Medicaid (75.8%) and the majority of chronic conditions among the sample were among racial and ethnic minorities. Interestingly, the majority of Optimus patients with a diagnosis of diabetes, hypertension and/or hyperlipidemia were between the ages of 30-54. Cultural Competency survey respondents noted difficulties in providing care due to language barriers, limited knowledge of intra-cultural group differences, and limited knowledge of how the causes of mental health are viewed by different cultural groups (Survey response rate: 22.4%). When asked to critique Optimus’ current cultural competency training, staff members reported efficiency as a strength and lack of applicability to a practical setting as a weakness, emphasizing the need for an interactive training. Conclusions and Recommendations: In concordance with the national trend, the results of our study indicate that Optimus patients of racial and ethnic minorities are disproportionally affected by chronic illness. Several areas were identified that can be targeted for improving the cultural competency knowledge, practice and delivery, and training needs of Optimus staff. Future studies should assess patient perceptions of cultural competency to allow for further insight into this emerging area of research.https://elischolar.library.yale.edu/ysph_pbchrr/1041/thumbnail.jp