# Optimizing Tobacco-Free Workplace Programs: Applying Rapid Qualitative Analysis to Adapt Interventions for Texas Healthcare Centers Serving Rural and Medically Underserved Patients

## TL;DR

This study uses rapid qualitative analysis to adapt a tobacco-free workplace program for healthcare centers in rural Texas, aiming to reduce tobacco-related cancer disparities among patients with substance use disorders.

## Contribution

The study introduces a cost-effective, real-time adaptation framework using rapid qualitative analysis to tailor tobacco cessation programs for rural healthcare settings.

## Key findings

- Rapid qualitative analysis identified key barriers like limited tobacco cessation support and attitudinal conflicts among staff and patients.
- Participants requested tailored educational materials, training, and nicotine replacement therapy to improve program adoption.
- The approach enabled systematic adaptation of the program to local contexts, enhancing implementation potential in underserved areas.

## Abstract

Despite smoking rates of 65–87%, adults with substance use disorders are rarely treated for tobacco use in healthcare centers when receiving treatment for non-nicotine substance use disorders in rural and medically underserved areas. Translation of evidence-based interventions for tobacco control is urgently needed to address tobacco-related cancer disparities among this group. We use a rapid qualitative analysis approach to advance adaptation of a tobacco-free workplace program in Texas healthcare centers serving adults with substance use disorders in rural and medically underserved areas. Rapid analysis of separate group interviews with staff and patients produced actionable findings to quickly optimize program fit, better address real-world conditions and program barriers, and enhance implementation to local contexts. This cost-effective, collaborative approach provides a framework for researchers to address site-specific needs in close to real-time to implement tobacco cessation efforts that reduce tobacco-related cancers for these disparately impacted patients in rural areas.

Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n = 34) and managers (n = 12) and 4 with patients (n = 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake.