Lisa Gaarde Hartsock, MPH¹, Kavita P. Ahluwalia, DDS, MPH², Cindy Laton¹, Sallie Beth Johnson, MPH¹, and Scott Thomas, PhD³. (1) Community Health Services, FirstHealth of the Carolinas, 155 Memorial Dr, PO Box 3000, Pinehurst, NC 28374, (910) 215-1922, lhartsock@firsthealth.org, (2) School of Dental and Oral Surgery, Columbia University, Division of Community Health, 630 West 168 St, New York, NY 10032, (3) Division of Community Health, Columbia University, 630 West 168 St, New York, NY 10032

Given the unique social makeup of rural communities, the development and implementation of cessation programs requires consideration of factors such as media, social structures, and provider-patient roles and expectations. FirstHealth of the Carolinas, a health care delivery system in rural N. Carolina has developed a program which utilizes providers to identify and refer clients to cessation services. Because N. Carolina is a tobacco growing state, and because there are no large media driven educational initiatives, FirstHealth has to rely on providers to educate patients about tobacco-related risks. In addition, since the primary method to gain visibility remains word-of-mouth, constant engagement of providers is important for effective referral and patient success. Although FirstHealth’s program does record high 6-month quit rates (45%) in clients who complete the program, only 60% (n =390) of those referred completed the cessation program. Focus group methodology used to determine provider- and client-level factors that may have an effect on client retention revealed that providers require relevant health education materials, more time with patients to set expectations and additional information about pharmaceutical aides. Client-related barriers to participation included lack of pharmaceutical aides and the lack of group cessation services; given the close-knit social structure of the community, it was assumed that clients would prefer private one-on-one cessation classes, but the focus groups revealed that they prefer group interactions. These data were used to implement a number of programmatic provider and client-level changes, which have been successful in increasing the number of referrals to cessation services.

Learning Objectives:

• Identify methods to assess program data and formally collect participant feedback.
• List factors that are important to assess when developing cessation programs in rural communities
• Describe strategies on how to use provider and participant feedback to simplify and streamline identification, referral and prescription mechanisms.
• Describe strategies on how to use participant feedback to improve the participants’ retention rate.

Keywords: Rural Health Service Providers, Behavior Modification

Related Web page: www.firsthealth.org

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: FirstHealth of the Carolinas, Inc
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.