Ecological analysis of an intervention study of smoking cessation in medical practices

This study began as an investigation of the feasibility of a brief, multifaceted primary care smoking cessation intervention in two primary care medical settings. When the investigators experienced a series of problems and setbacks in implementing the protocol in both settings, they turned their attention to the ecological disturbances created in the health care settings when outside researchers intervened. This paper analyzes the interaction patterns that complicated the research enterprise, particularly the triangles among the research team, the nurses, and the physicians. It also describes steps taken by the research team to deal with these ecological/systems problems. The authors raise these issues to help other researchers who encounter similar problems in community-based research, problems which are rarely discussed in the research literature.