Clinicians' Perspectives on Implementing Contingency Management to Promote Parental Smoking Cessation in Routine...

Pediatric clinicians routinely screen for secondhand smoke exposure and are uniquely poised to support caregivers. Infancy is a critical period of exposure and caregiver behavior change. We explored clinician perspectives regarding contingency management (CM), an evidence-based smoking cessation intervention not previously used in pediatric primary care for infant parents/caregivers.

The sample included clinicians/staff at a Federally Qualified Health Center and nursery in the Northeastern United States. We used sequential mixed methods with survey and qualitative methodologies to characterize pediatric clinicians' attitudes, awareness, and perceptions of CM. Using linear regression, we assessed characteristics associated with responses to the CM Beliefs Questionnaire. We conducted a framework analysis of interview transcripts using Consolidated Framework for Implementation Research and mapped barriers to relevant implementation strategies.

Among 72 (39% of eligible) survey respondents, most were prescribing clinicians (82%), not trainees (58%), and in practice for 10 or fewer years (72%). Most (57%) were familiar with CM, with high mean scores for pro-CM sentiment. Attending physicians, those with awareness of CM, a personal smoking history, and positive views of caregivers who smoke had more favorable CM sentiment. We reached thematic saturation after 9 interviews. Barriers to CM implementation (poor outcome expectancy, caregiver/clinician burden, and perceived complexity) mapped to implementation strategies of promoting adaptability, clinician education, building a coalition, and developing partnerships.

Most pediatric clinicians endorsed the potential for CM to promote smoking cessation for infant parents/caregivers. Barriers may be overcome with a multifaceted strategy with comprehensive clinician/staff training, leveraging patients, community, and academic partnerships.