Donna Shelley

Professor of Public Health Policy and Management

Co-Director of the Global Center for Implementation Science

Professional overview

Dr. Shelley is a tenured Professor in the Department of Public Health Policy and Management and the founding Co-Director of the Global Center for Implementation Science at the NYU School of Global Public Health. She conducts translational, population-based, and policy-relevant research that aims to accelerate dissemination and implementation of tobacco use treatment in safety net health care delivery systems and implementation of tobacco control policies. This research has been funded by the National Cancer Institute (NCI), National Institute of Drug Abuse, National Heart, Lung, and Blood Institute, the Agency for Healthcare Research and Quality, and the New York State Department of Health.

Dr. Shelley’s implementation research focuses on building the evidence for effective theory-driven strategies that target barriers to implementation and sustainability of evidence-based tobacco use treatment in primary care settings in the U.S. and Viet Nam. Her research is also addressing the growing dual burden of noncommunicable and communicable diseases in LMICs and, specifically, the health impact on people living with HIV/AIDS.  Her policy research includes a completed NCI-funded study that evaluated the impact of the US federally mandated smoke-free public housing policy on exposure to secondhand smoke and explored the implementation process to identify strategies with the potential to improve the process and maximize public health impact.

Education

BS, University of Pennsylvania, PA

MD, Mount Sinai School of Medicine, NY

MPH, Health Policy and Management, Columbia University's Mailman School of Public Health, NY

Areas of research and study

Health Systems Strengthening

Implementation science

Tobacco Cessation

Tobacco Policy

Current Research

Policy

Purtle J, Moucheraud C, Yang LH, Shelley D. Four very basic ways to think about policy in implementation science. Implement Sci Commun. 2023 Sep 12;4(1):11

Shelley D. Kyriakas C, McNeill A, Murray R, Nilan K, Sherman SE, Raw M. Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis. Addiction. 2020;115:527-533

Thorpe L, Anastasiou E, Wyka K, Tovar A, Gill E, Rule A, Elbel B, Kaplan SA, Jiang N, Gordon T, Shelley D. Evaluation of Secondhand Smoke Exposure in New York City Public Housing After Implementation of the 2018 Federal Smoke-Free Housing Policy. JAMA Netw Open. 2020 Nov 2;3(11):e2024385

Tobacco cessation 

Hoang THL … Shelley D. Factors Influencing Tobacco Smoking and Cessation Among People Living  with HIV: A Systematic Review and Meta‑analysis. AIDS and Behavior. 2024 https://doi.org/10.1007/s10461-024-04279-1

Shelley et al. WHO Knowledge Summary: Tobacco and HIV https://iris.who.int/bitstream/handle/10665/378509/9789240096868-eng.pdf

Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials. 2022 Aug 17;23(1):664.

Health systems improvement and Implementation Science

Nwaozuru U, Murphy P, Richard A, …Shelley D, Airhihenbuwa C, Ogedegbe G, Ezechi O, Iwelunmor J. The sustainability of health interventions implemented in Africa: an updated systematic review on evidence and future research perspectives. Implement Sci Commun. 2025 Apr 8;6(1):39. https://pmc.ncbi.nlm.nih.gov/articles/PMC11980204/ 

Gaeta Gazzola M, Torsiglieri A, Velez L, Blaufarb S, Hernandez P, O'Grady MA, Blackburn J, Florick J, Cleland CM, Shelley D, Doran KM A community-academic partnership to develop an implementation support package for overdose prevention in permanent supportive housing. J Subst Use Addict Treat. 2025 Jan;168:209533. doi: 10.1016/j.josat.2024.209533. Epub 2024 Oct 9.PMID: 39389548

Kilbourne AM, Geng E, Eshun-Wilson I, Sweeney S, Shelley D, Cohen DJ, Kirchner JE, Fernandez ME, Parchman ML. How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy. Implement Sci Commun. 2023 May 16;4(1):53. 

Parascandola M, Neta G, Salloum RG, Shelley D, Rositch AF.JCO Glob Oncol. Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control.2022 Aug;8:e2200054.

Shelley D, Alvarez GG, Nguyen T, Nguyen N, Goldsamt L, Cleland C, Tozan Y, Shuter J, Armstrong-Hough M. Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study. Implement Sci Commun. 2022 Oct 17;3(1):112. 

Shelley D, Wang VH, Taylor K, Williams R, Toll B, Rojewski A, Foley KL, Rigotti N, Ostroff JS. Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice. Transl Behav Med. 2022 Nov 21;12(11):1076-1083.

Shelley D, Cleland CM, Nguyen T, VanDevanter N, Siman N, Van Minh H, Nguyen N. Nicotine Tob Res. Effectiveness of a Multicomponent Strategy for Implementing Guidelines for Treating Tobacco Use in Vietnam Commune Health Centers 2022 Feb 1;24(2):196-203.

Hennein R, Ggita J, Ssuna B, Shelley D, Akiteng AR, Davis JL, Katamba A, Armstrong-Hough M. Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption. Glob Public Health. 2022 Aug-Sep;17(9):1868-1882

Publications

Publications

Clinician perspectives on the benefits of practice facilitation for small primary care practices

Rogers, E. S., Cuthel, A. M., Berry, C. A., Kaplan, S. A., & Shelley, D. (n.d.).

Publication year

2019

Journal title

Annals of family medicine

Volume

17

Issue

Suppl 1

Page(s)

S17-S23

10.1370/afm.2427

Abstract

Abstract

PURPOSE Small independent primary care practices (SIPs) often lack the resources to implement system changes. HealthyHearts NYC, funded through the EvidenceNOW initiative of the Agency for Healthcare Research and Quality, studied the effectiveness of practice facilitation to improve cardiovascular disease– related care in 257 SIPs. We sought to understand SIP clinicians’ perspectives on the benefits of practice facilitation. METHODS We conducted in-depth interviews with 19 SIP clinicians enrolled in HealthyHearts NYC. Interviews were transcribed and coded using deductive and inductive approaches. To understand whether the perceived benefits of practice facilitation differ based on the availability of internal staff for quality improvement (QI), we compared themes pertaining to benefits between practices with 3 or fewer office staff vs more than 3 office staff. RESULTS Clinicians perceived 2 main benefits of practice facilitation. First, facilitators served as a connection to the external health care environment for SIPs, often through teaching and information sharing. Second, facilitators provided electronic health record (EHR)/data expertise, often by teaching functionality and completing technical assistance and tasks. SIPs with more than 3 office staff felt that facilitators provided benefits primarily through teaching, whereas SIPs with 3 or fewer staff felt that facilitators also provided hands-on support. At the intersections of these benefits, there emerged 3 central practice facilitation benefits: (1) creating awareness of quality gaps, (2) connecting practices to information, resources, and strategies, and (3) optimizing the EHR for QI goals. CONCLUSIONS SIP clinicians perceived practice facilitation to be an important resource for connecting their practice to the external health care environment and resources, and helping their practice build QI capacity through teaching, hands-on support, and EHR-driven solutions.

eBook: Methods and applications in implementation science

Northridge, M. E., Shelley, D., Rundall, T. G., & Brownson, R. C. (n.d.).

Publication year

2019

Journal title

Frontiers in Public Health

Page(s)

1-231

Abstract

Abstract

The purpose of this Research Topic is to share the latest developments in the methods and application of implementation science. Briefly, implementation science is the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings. Implementation research plays an important role in identifying barriers to, and enablers of, effective health systems programming and policymaking, and then leveraging that knowledge to implement evidence-based innovations into effective delivery approaches.

Editorial : Methods and Applications in Implementation Science

Northridge, M. E., Shelley, D., Rundall, T. G., & Brownson, R. C. (n.d.).

Publication year

2019

Journal title

Frontiers in Public Health

Volume

7

10.3389/fpubh.2019.00213

Abstract

Abstract

~

Effectiveness of Village Health Worker-Delivered Smoking Cessation Counseling in Vietnam

Jiang, N., Siman, N., Cleland, C. M., Van Devanter, N. L., Nguyen, T., Nguyen, N., & Shelley, D. (n.d.).

Publication year

2019

Journal title

Nicotine and Tobacco Research

Volume

21

Issue

11

Page(s)

1524-1530

10.1093/ntr/nty216

Abstract

Abstract

Introduction: Smoking prevalence is high in Vietnam, yet tobacco dependence treatment (TDT) is not widely available. Methods: We conducted a quasiexperimental study that compared the effectiveness of health care provider advice and assistance (ARM 1) versus ARM 1 plus village health worker (VHW) counseling (ARM 2) on abstinence at 6-month follow-up. This study was embedded in a larger two-arm cluster randomized controlled trial conducted in 26 community health centers (CHCs) in Vietnam. Subjects (N = 1318) were adult patients who visited any participating CHC during the parent randomized controlled trial intervention period and were self-identified as current tobacco users (cigarettes and/or water pipe). Results: At 6-month follow-up, abstinences rates in ARM 2 were significantly higher than those in ARM 1 (25.7% vs. 10.5%; p

Interrupting providers with clinical decision support to improve care for heart failure

Blecker, S., Austrian, J. S., Horwitz, L. I., Kuperman, G., Shelley, D., Ferrauiola, M., & Katz, S. D. (n.d.).

Publication year

2019

Journal title

International Journal of Medical Informatics

Volume

131

10.1016/j.ijmedinf.2019.103956

Abstract

Abstract

Background: Evidence-based therapy for heart failure remains underutilized at hospital discharge, particularly for patients with heart failure who are hospitalized for another cause. We developed clinical decision support (CDS) to recommend an angiotensin converting enzyme (ACE) inhibitor during hospitalization to promote its continuation at discharge. The CDS was designed to be implemented in both interruptive and non-interruptive versions. Objectives: To compare the effectiveness and implementation of interruptive and non-interruptive versions of a CDS to improve care for heart failure. Methods: Hospitalizations of patients with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on even or odd medical record number. We compared discharge utilization of an ACE inhibitor or angiotensin receptor blocker (ARB) for these two implementation approaches. We also assessed adoption and implementation fidelity of the CDS. Results: Of 958 hospitalizations, interruptive alert hospitalizations had higher rates of discharge utilization of ACE inhibitors or ARBs than non-interruptive alert hospitalizations (79.6% vs. 74.2%, p = 0.05). Utilization was higher for interruptive alert versus non-interruptive alert hospitalizations which were principally for causes other than heart failure (79.8% vs. 73.4%; p = 0.05) but no difference was observed among hospitalizations with a principal heart failure diagnosis (85.9% vs.81.7%; p = 0.49). As compared to non-interruptive hospitalizations, interruptive alert hospitalizations were more likely to have had: an alert with any response (40.6% vs. 13.1%, p < 0.001), contraindications reported (33.1% vs 11.3%, p < 0.001), and an ACE inhibitor ordered within twelve hours of the alert (17.6% vs 10.3%, p < 0.01). The response rate for the interruptive alert was 1.7%, and a median (25th, 75th percentile) of 14 (5,32) alerts were triggered per hospitalization. Conclusions: A CDS implemented as an interruptive alert was associated with improved quality of care for heart failure. Whether the potential benefits of CDS in improving cardiovascular care were worth the high burden of interruptive alerts deserves further consideration. ClinicalTrials.gov Identifier: NCT02858674.

Interruptive versus noninterruptive clinical decision support : Usability study

Blecker, S., Pandya, R., Stork, S., Mann, D., Kuperman, G., Shelley, D., & Austrian, J. S. (n.d.).

Publication year

2019

Journal title

JMIR Human Factors

Volume

6

Issue

2

10.2196/12469

Abstract

Abstract

Background: Clinical decision support (CDS) has been shown to improve compliance with evidence-based care, but its impact is often diminished because of issues such as poor usability, insufficient integration into workflow, and alert fatigue. Noninterruptive CDS may be less subject to alert fatigue, but there has been little assessment of its usability. Objective: This study aimed to study the usability of interruptive and noninterruptive versions of a CDS. Methods: We conducted a usability study of a CDS tool that recommended prescribing an angiotensin-converting enzyme inhibitor for inpatients with heart failure. We developed 2 versions of the CDS: an interruptive alert triggered at order entry and a noninterruptive alert listed in the sidebar of the electronic health record screen. Inpatient providers were recruited and randomly assigned to use the interruptive alert followed by the noninterruptive alert or vice versa in a laboratory setting. We asked providers to “think aloud” while using the CDS and then conducted a brief semistructured interview about usability. We used a constant comparative analysis informed by the CDS Five Rights framework to analyze usability testing. Results: A total of 12 providers participated in usability testing. Providers noted that the interruptive alert was readily noticed but generally impeded workflow. The noninterruptive alert was felt to be less annoying but had lower visibility, which might reduce engagement. Provider role seemed to influence preferences; for instance, some providers who had more global responsibility for patients seemed to prefer the noninterruptive alert, whereas more task-oriented providers generally preferred the interruptive alert. Conclusions: Providers expressed trade-offs between impeding workflow and improving visibility with interruptive and noninterruptive versions of a CDS. In addition, 2 potential approaches to effective CDS may include targeting alerts by provider role or supplementing a noninterruptive alert with an occasional, well-timed interruptive alert.

Study protocol for a pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) model for engaging patients in opioid use disorder treatment

McNeely, J., Troxel, A. B., Kunins, H. V., Shelley, D., Lee, J. D., Walley, A., Weinstein, Z. M., Billings, J. C., Davis, N. J., Marcello, R. K., Schackman, B. R., Barron, C., & Bergmann, L. (n.d.).

Publication year

2019

Journal title

Addiction science &amp; clinical practice

Volume

14

Issue

1

Page(s)

5

10.1186/s13722-019-0135-7

Abstract

Abstract

BACKGROUND: Treatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized. Individuals with OUD have disproportionately high rates of hospitalization and low rates of addiction treatment. Hospital-based addiction consult services offer a potential solution by using multidisciplinary teams to evaluate patients, initiate medication for addiction treatment (MAT) in the hospital, and connect patients to post-discharge care. We are studying the effectiveness of an addiction consult model [Consult for Addiction Treatment and Care in Hospitals (CATCH)] as a strategy for engaging patients with OUD in treatment as the program rolls out in the largest municipal hospital system in the US. The primary aim is to evaluate the effectiveness of CATCH in increasing post-discharge initiation and engagement in MAT. Secondary aims are to assess treatment retention, frequency of acute care utilization and overdose deaths and their associated costs, and implementation outcomes. METHODS: A pragmatic trial at six hospitals, conducted in collaboration with the municipal hospital system and department of health, will be implemented to study the CATCH intervention. Guided by the RE-AIM evaluation framework, this hybrid effectiveness-implementation study (Type 1) focuses primarily on effectiveness and also measures implementation outcomes to inform the intervention's adoption and sustainability. A stepped-wedge cluster randomized trial design will determine the impact of CATCH on treatment outcomes in comparison to usual care for a control period, followed by a 12-month intervention period and a 6- to 18-month maintenance period at each hospital. A mixed methods approach will primarily utilize administrative data to measure outcomes, while interviews and focus groups with staff and patients will provide additional information on implementation fidelity and barriers to delivering MAT to patients with OUD. DISCUSSION: Because of their great potential to reduce the negative health and economic consequences of untreated OUD, addiction consult models are proliferating in response to the opioid epidemic, despite the absence of a strong evidence base. This study will provide the first known rigorous evaluation of an addiction consult model in a large multi-site trial and promises to generate knowledge that can rapidly transform practice and inform the potential for widespread dissemination of these services. TRIAL REGISTRATION: NCT03611335.

The DREAM Initiative : Study protocol for a randomized controlled trial testing an integrated electronic health record and community health worker intervention to promote weight loss among South Asian patients at risk for diabetes

Lim, S., Wyatt, L. C., Mammen, S., Zanowiak, J. M., Mohaimin, S., Goldfeld, K. S., Shelley, D., Gold, H. T., & Islam, N. S. (n.d.).

Publication year

2019

Journal title

Trials

Volume

20

Issue

1

10.1186/s13063-019-3711-y

Abstract

Abstract

Background: Electronic health record (EHR)-based interventions that use registries and alerts can improve chronic disease care in primary care settings. Community health worker (CHW) interventions also have been shown to improve chronic disease outcomes, especially in minority communities. Despite their potential, these two approaches have not been tested together, including in small primary care practice (PCP) settings. This paper presents the protocol of Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, a 5-year randomized controlled trial integrating both EHR and CHW approaches into a network of PCPs in New York City (NYC) in order to support weight loss efforts among South Asian patients at risk for diabetes. Methods/design: The DREAM Initiative was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (National Institutes of Health). A total of 480 individuals at risk for type 2 diabetes will be enrolled into the intervention group, and an equal number will be included in a matched control group. The EHR intervention components include the provision of technical assistance to participating PCPs regarding prediabetes-related registry reports, alerts, and order sets. The CHW intervention components entail group education sessions on diabetes prevention, including weight loss and nutrition. A mixed-methods approach will be used to evaluate the feasibility, adoption, and impact (≥ 5% weight loss) of the integrated study components. Additionally, a cost effectiveness analysis will be conducted using outcomes, implementation costs, and healthcare claims data to determine the incremental cost per person achieving 5% weight loss. Discussion: This study will be the first to test the efficacy of an integrated EHR-CHW intervention within an underserved, minority population and in a practical setting via a network of small PCPs in NYC. The study's implementation is enhanced through cross-sector partnerships, including the local health department, a healthcare payer, and EHR vendors. Through use of a software platform, the study will also systematically track and monitor CHW referrals to social service organizations. Study findings, including those resulting from cost-effectiveness analyses, will have important implications for translating similar strategies to other minority communities in sustainable ways. Trial registration: This study protocol has been approved and is made available on ClinicalTrials.gov by NCT 03188094 as of 15 June 2017.

“It Wasn't Just One Thing” : A Qualitative Study of Newly Homeless Emergency Department Patients

Doran, K. M., Ran, Z., Castelblanco, D., Shelley, D., & Padgett, D. K. (n.d.).

Publication year

2019

Journal title

Academic Emergency Medicine

Volume

26

Issue

9

Page(s)

982-993

10.1111/acem.13677

Abstract

Abstract

Objectives: Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions. Methods: We conducted in-depth, one-on-one qualitative interviews with ED patients who had become homeless within the past 6 months. Using a semistructured interview guide, we asked patients about their pathways into homelessness and what might have prevented them from becoming homeless. Interviews were digitally recorded and professionally transcribed. Transcripts were coded line by line by multiple investigators who then met as a group to discuss and refine codes in an iterative fashion. Results: Interviews were completed with 31 patients. Mean interview length was 42 minutes. Four main themes emerged: 1) unique stories yet common social and health contributors to homelessness, 2) personal agency versus larger structural forces, 3) limitations in help from family or friends, and 4) homelessness was not expected. Conclusions: These findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More immediately, the findings provide rich, unique context to the lives of a vulnerable patient population commonly seen in EDs.

A Tale of 2 Constituencies

Goytia, C. N., Kastenbaum, I., Shelley, D., Horowitz, C. R., & Kaushal, R. (n.d.).

Publication year

2018

Journal title

Medical care

Volume

56

Page(s)

S64-S69

10.1097/MLR.0000000000000786

Abstract

Abstract

Background: Patient and clinician stakeholders are inadequately engaged in key aspects of research, particularly regarding use of Big Data to study and improve patient-centered outcomes. Little is known about the attitudes, interests, and concerns of stakeholders regarding such data. Research Design: The New York City Clinical Data Research Network (NYC-CDRN), a collaboration of research, clinical, and community leaders built a deidentified dataset containing electronic health records from millions of New Yorkers. Guided by a patient-clinician advisory board, we developed a question guide to explore patient and clinician experiences and ideas about research using large datasets. Trained facilitators led discussions during preexisting patient, community, and clinician group meetings. The research team coded meeting notes and identified themes. Results: Fully 272 individuals participated in 19 listening sessions (139 patients/advocates, 133 clinicians) at 6 medical centers with diverse NYC communities: 76% were female and 63% were nonwhite. Clinicians and patients agreed on all major themes including the central role of clinicians in introducing patients to research and the need for public campaigns to inform stakeholders about Big Data. Stakeholders were interested in using granular data to compare the care and clinical outcomes of their neighborhoods with others across NYC, but were also concerned that data could not truly be deidentified. Conclusions: Clinicians and patients agree on potential benefits of stakeholder-engaged Big Data research and provided suggestions for further research and building stakeholder research capacity. This evaluation demonstrated the potential of brief meetings with existing patient and clinical groups to explore barriers and facilitators to patient and clinician engagement.

An analysis of adaptations to multi-level intervention strategies to enhance implementation of clinical practice guidelines for treating tobacco use in dental care settings

Shelley, D., Shelley, D. R., Kyriakos, C., Campo, A., Li, Y., Khalife, D., & Ostroff, J. (n.d.).

Publication year

2018

Journal title

Contemporary Clinical Trials Communications

Volume

11

Page(s)

142-148

10.1016/j.conctc.2018.07.003

Abstract

Abstract

Introduction: Our team conducted a cluster randomized controlled trial (DUET) that compared the effectiveness of three theory-driven, implementation strategies on dental provider adherence to tobacco dependence treatment guidelines (TDT). In this paper we describe the process of adapting the implementation strategies to the local context of participating dental public health clinics in New York City. Methods: Eighteen dental clinics were randomized to one of three study arms testing several implementation strategies: Current Best Practices (CBP) (i.e. staff training, clinical reminder system and Quitline referral system); CBP + Performance Feedback (PF) (i.e. feedback reports on provider delivery of TDT); and CBP + PF + Pay-for-Performance (i.e. financial incentives for provision of TDT). Through an iterative process, we used Stirman's modification framework to classify, code and analyze modifications made to the implementation strategies. Results: We identified examples of six of Stirman's twelve content modification categories and two of the four context modification categories. Content modifications were classified as: tailoring, tweaking or refining (49.8%), adding elements (14.1%), departing from the intervention (9.3%), loosening structure (4.4%), lengthening and extending (4.4%) and substituting elements (4.4%). Context modifications were classified as those related to personnel (7.9%) and to the format/channel (8.8%) of the intervention delivery. Common factors associated with adaptations that arose during the intervention included staff changes, time constraints, changes in leadership preferences and functional limitations of to the Electronic Dental Record. Conclusions: This study offers guidance on how to capture intervention adaptation in the context of a multi-level intervention aimed at implementing sustainable changes to optimize TDT in varying public health dental settings.

Correlates of burnout in small independent primary care practices in an urban setting

Blechter, B., Jiang, N., Cleland, C., Berry, C., Ogedegbe, O., & Shelley, D. (n.d.).

Publication year

2018

Journal title

Journal of the American Board of Family Medicine

Volume

31

Issue

4

Page(s)

529-536

10.3122/jabfm.2018.04.170360

Abstract

Abstract

Background: Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (

Perceptions about the federally mandated smoke-free housing policy among residents living in public housing in New York city

Jiang, N., Thorpe, L., Kaplan, S., & Shelley, D. (n.d.).

Publication year

2018

Journal title

International journal of environmental research and public health

Volume

15

Issue

10

10.3390/ijerph15102062

Abstract

Abstract

Background: To assess residents’ attitudes towards the United States (U.S.) Department of Housing and Urban Development’s new smoke-free public housing policy, perceptions about barriers to policy implementation, and suggestions for optimizing implementation. Methods: In 2017, we conducted 10 focus groups among 91 residents (smokers and nonsmokers) living in New York City public housing. Results: Smokers and nonsmokers expressed skepticism about the public housing authority’s capacity to enforce the policy due to widespread violations of the current smoke-free policy in common areas and pervasive use of marijuana in buildings. Most believed that resident engagement in the roll-out and providing smoking cessation services was important for compliance. Resident expressed concerns about evictions and worried that other building priorities (i.e., repairs, drug use) would be ignored with the focus now on smoke-free housing. Conclusions: Resident-endorsed strategies to optimize implementation effectiveness include improving the access to cessation services, ongoing resident engagement, education and communication to address misconceptions and concerns about enforcement, and placing smoke-free homes in a larger public housing authority healthy housing agenda.

Quality of cardiovascular disease care in small urban practices

Shelley, D., Blechter, B., Siman, N., Jiang, N., Cleland, C., Ogedegbe, G., Williams, S., Wu, W., Rogers, E., & Berry, C. (n.d.).

Publication year

2018

Journal title

Annals of family medicine

Volume

16

Page(s)

S21-S28

10.1370/afm.2174

Abstract

Abstract

PURPOSE We wanted to describe small, independent primary care practices’ performance in meeting the Million Hearts ABCSs (aspirin use, blood pressure control, cholesterol management, and smoking screening and counseling), as well as on a composite measure that captured the extent to which multiple clinical targets are achieved for patients with a history of arteriosclerotic cardiovascular disease (ASCVD). We also explored relationships between practice characteristics and ABCS measures. METHODS We conducted a cross-sectional, bivariate analysis using baseline data from 134 practices in New York City. ABCS data were extracted from practices’ electronic health records and aggregated to the site level. Practice characteristics were obtained from surveys of clinicians and staff at each practice. RESULTS The proportion of at-risk patients meeting clinical goals for each of the ABCS measures was 73.0% for aspirin use, 69.6% for blood pressure, 66.7% for cholesterol management, and 74.2% screened for smoking and counseled. For patients with a history of ASCVD, only 49% were meeting all ABC (aspirin use, blood pressure control, cholesterol management) targets (ie, composite measure). Solo practices were more likely to meet clinical guidelines for aspirin (risk ratio [RR ] = 1.17, P = .007) and composite (RR = 1.29, P = .011) than practices with multiple clinicians. CONCLUSION Achieving targets for ABCS measures varied considerably across practices; however, small practices were meeting or exceeding Million Hearts goals (ie, 70% or greater). Practices were less likely to meet consistently clinical targets that apply to patients with a history of ASCVD risk factors. Greater emphasis is needed on providing support for small practices to address the complexity of managing patients with multiple risk factors for primary and secondary ASCVD.

Social norms and self-efficacy to quit waterpipe use : Findings from a tobacco study among male smokers in rural Viet Nam

Kumar, P. C., Cleland, C. M., Latkin, C., VanDevanter, N., Siman, N., Nguyen, T., Nguyen, L., Nguyen, N., & Shelley, D. (n.d.).

Publication year

2018

Journal title

Journal of Smoking Cessation

Volume

13

Issue

3

Page(s)

154-161

10.1017/jsc.2017.20

Abstract

Abstract

Introduction: Waterpipe use is a significant health concern in low- A nd middle-income countries like Viet Nam, yet there is a lack of research on factors that may influence use and self-efficacy to quit among adults. Aims: This study examined the relationship between social norms related to waterpipe use and self-efficacy to quit among male waterpipe smokers in Viet Nam. Methods: A cross-sectional survey was conducted with 214 adult male waterpipe smokers enrolled in a large cluster-randomised controlled trial conducted in a rural province in Viet Nam. Associations between social norms related to waterpipe smoking and the participants' confidence to quit waterpipes were assessed using hierarchical regression models to account for differences among study sites and other covariates. Results: Self-efficacy to quit smoking was positively associated with immediate family members' not minding participants smoking and with extended family's encouragement to quit smoking. Conclusions: The findings suggest the need for a more comprehensive understanding of the functions and characteristics of the social context of waterpipe smoking, including the social networks of waterpipe smokers, to inform effective cessation interventions for waterpipe smokers.

Substance use and homelessness among emergency department patients

Doran, K. M., Rahai, N., McCormack, R. P., Milian, J., Shelley, D., Rotrosen, J., & Gelberg, L. (n.d.).

Publication year

2018

Journal title

Drug and alcohol dependence

Volume

188

Page(s)

328-333

10.1016/j.drugalcdep.2018.04.021

Abstract

Abstract

Background: Homelessness and substance use often coexist, resulting in high morbidity. Emergency department (ED) patients have disproportionate rates of both homelessness and substance use, yet little research has examined the overlap of these issues in the ED setting. We aimed to characterize alcohol and drug use in a sample of homeless vs. non-homeless ED patients. Methods: A random sample of urban hospital ED patients were invited to complete an interview regarding housing, substance use, and other health and social factors. We compared substance use characteristics among patients who did vs. did not report current literal (streets/shelter) homelessness. Additional analyses were performed using a broader definition of homelessness in the past 12-months. Results: Patients who were currently homeless (n = 316, 13.7%) versus non-homeless (n = 1,993, 86.3%) had higher rates of past year unhealthy alcohol use (44.4% vs. 30.5%, p

Text2Connect : A health system approach to engage tobacco users in quitline cessation services via text messaging

Krebs, P., Sherman, S. E., Wilson, H., El-Shahawy, O., Abroms, L. L., Zhao, X., Nahvi, S., & Shelley, D. (n.d.).

Publication year

2018

Journal title

Translational Behavioral Medicine

Volume

10

Issue

1

Page(s)

292-301

10.1093/tbm/ibz033

Abstract

Abstract

Mobile technology has created the opportunity for health systems to provide low cost tobacco cessation assistance to patients. The goal of the present study was to examine the feasibility and effectiveness of an intervention (Text2Connect) that uses text messages to offer proactive connection to the New York State Smokers' Quitline. The electronic health record at two urban health systems was queried for patients who were current smokers and who had an outpatient visit between March 2015 and February 2016. Smokers (N = 4000) were sent an informational letter. Those who did not opt out (N = 3719) were randomized to one of 6 message sequences in order to examine the effect of theoretically informed message frames on response rates. Participants were sent a series of text messages at baseline and at 1 month and were asked to reply in order to be contacted by the state quitline (QL). After removing 1403 nonworking numbers, texts were sent to 2316 patients, and 10.0% (205/2060) responded with a QL request. Almost one quarter (23.6%, 486/2060) replied STOP and 66.4% (1369/2060) never responded. QL request rates were significantly higher when response efficacy messages were not used (p . 05). The Text2Connect intervention was well accepted with a minority opting out. A 10% QL response rate is noteworthy given that only 5-7 brief outreach text messages were used. Results indicate that simple self-efficacy-focused messaging is most effective at supporting response rates.

Time to Track Health Outcomes of Smoke-Free Multiunit Housing

Thorpe, L. E., Feinberg, A. M., Elbel, B., Gordon, T., Kaplan, S. A., Wyka, K., Athens, J., & Shelley, D. (n.d.).

Publication year

2018

Journal title

American journal of preventive medicine

Volume

54

Issue

2

Page(s)

320-322

10.1016/j.amepre.2017.09.016

Abstract

Abstract

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Tobacco cessation in Vietnam : Exploring the role of village health workers

Nguyen, N., Nguyen, T., Chapman, J., Nguyen, L., Kumar, P., VanDevanter, N., & Shelley, D. (n.d.).

Publication year

2018

Journal title

Global Public Health

Volume

13

Issue

9

Page(s)

1265-1275

10.1080/17441692.2017.1360376

Abstract

Abstract

The purpose of this study was to explore current tobacco use treatment (TUT) practice patterns, and attitudes and beliefs among Village Health Workers (VHWs) about expanding their role to include delivering smoking cessation interventions and the perceived barriers. We conducted a survey of 449 VHWs from 26 communes in Thai Nguyen province, Vietnam. We assessed TUT practice patterns including asking about tobacco use, advising smokers to quit, offering assistance (3As) and attitudes, self-efficacy, and norms related to TUT. Seventy two per cent of VHWs reported asking patients if they use tobacco, 78.6% offered advice to quit, and 41.4% offered cessation assistance to few or more patients in the past month. Self-efficacy was low, with 53.2% agreeing that they did not have the skills to counsel patients about smoking cessation. The most commonly reported barriers to offering TUT were a lack of training and perceived lack of patient interest. Greater awareness of their commune health centre’s smoke-free policy and higher levels of self-efficacy were associated with screening and offering cessation assistance. VHWs support an expanded role in tobacco cessation, but require additional resources and training to increase their self-efficacy and skills to provide effective treatment.

Unpacking Partnership, Engagement, and Collaboration Research to Inform Implementation Strategies Development : Theoretical Frameworks and Emerging Methodologies

Huang, K. Y., Kwon, S. C., Cheng, S., Kamboukos, D., Shelley, D., Brotman, L. M., Kaplan, S. A., Olugbenga, O., & Hoagwood, K. (n.d.).

Publication year

2018

Journal title

Frontiers in Public Health

Volume

6

10.3389/fpubh.2018.00190

Abstract

Abstract

Background: Partnership, engagement, and collaboration (PEC) are critical factors in dissemination and implementation (D&I) research. Despite a growing recognition that incorporating PEC strategies in D&I research is likely to increase the relevance, feasibility, impacts, and of evidence-based interventions or practices (EBIs, EBPs), conceptual frameworks and methodologies to guide the development and testing of PEC strategies in D&I research are lacking. To address this methodological gap, a review was conducted to summarize what we know, what we think we know, and what we need to know about PEC to inform D&I research. Methods: A cross-field scoping review, drawing upon a broad range of PEC related literature in health, was conducted. Publications reviewed focused on factors influencing PEC, and processes, mechanisms and strategies for promoting effective PEC. The review was conducted separately for three forms of partnerships that are commonly used in D&I research: (1) consumer-provider or patient-implementer partnership; (2) delivery system or implementation team partnership; and (3) sustainment/support or interagency/community partnership. A total of 39 studies, of which 21 were review articles, were selected for an in-depth review. Results: Across three forms of partnerships, four domains (cognitive, interpersonal/affective, behavioral, and contextual domains) were consistently identified as factors and strategies for promoting PEC. Depending on the stage (preparation or execution) and purpose of the partnership (regulating performance or managing maintenance), certain PEC strategies are more or less relevant. Recent developments of PEC frameworks, such as Partnership Stage of Change and multiple dynamic processes, provide more comprehensive conceptual explanations for PEC mechanisms, which can better guide PEC strategies selection and integration in D&I research. Conclusions: This review contributes to D&I knowledge by identifying critical domain factors, processes, or mechanisms, and key strategies for PEC, and offers a multi-level PEC framework for future research to build the evidence base. However, more research is needed to test PEC mechanisms.

Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system

VanDevanter, N., Kumar, P., Nguyen, N., Nguyen, L., Nguyen, T., Stillman, F., Weiner, B., & Shelley, D. (n.d.).

Publication year

2017

Journal title

Implementation science : IS

Volume

12

Issue

1

Page(s)

27

10.1186/s13012-017-0558-z

Abstract

Abstract

CONCLUSIONS: In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC.TRIAL REGISTRATION: NCT02564653 . Registered September 2015.BACKGROUND: Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC.METHODS: We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study.RESULTS: The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting).

Combining Text Messaging and Telephone Counseling to Increase Varenicline Adherence and Smoking Abstinence Among Cigarette Smokers Living with HIV : A Randomized Controlled Study

Tseng, T. Y., Krebs, P., Schoenthaler, A., Wong, S., Sherman, S., Gonzalez, M., Urbina, A., Cleland, C. M., & Shelley, D. (n.d.).

Publication year

2017

Journal title

AIDS and Behavior

Volume

21

Issue

7

Page(s)

1964-1974

10.1007/s10461-016-1538-z

Abstract

Abstract

Smoking represents an important health risk for people living with HIV (PLHIV). Low adherence to smoking cessation pharmacotherapy may limit treatment effectiveness. In this study, 158 participants recruited from three HIV care centers in New York City were randomized to receive 12-weeks of varenicline (Chantix) either alone as standard care (SC) or in combination with text message (TM) support or TM plus cell phone-delivered adherence-focused motivational and behavioral therapy (ABT). Generalized linear mixed-effect models found a significant decline in varenicline adherence from week 1–12 across treatment groups. At 12-weeks, the probability of smoking abstinence was significantly higher in SC+TM+ABT than in SC. The study demonstrates the feasibility of delivering adherence-focused interventions to PLHIV who smoke. Findings suggest intensive behavioral support is an important component of an effective smoking cessation intervention for this population, and a focus on improving adherence self-efficacy may lead to more consistent adherence and higher smoking abstinence.

Health care providers' adherence to tobacco treatment for waterpipe, cigarette and dual users in Vietnam

Shelley, D., Kumar, P., Lee, L., Nguyen, L. T., Nguyen, T. T., VanDevanter, N., Cleland, C. M., & Nguyen, N. T. (n.d.).

Publication year

2017

Journal title

Addictive Behaviors

Volume

64

Page(s)

49-53

10.1016/j.addbeh.2016.08.010

Abstract

Abstract

Background Almost half of adult men in Vietnam are current cigarette smokers. Recent surveys also suggest a high prevalence of water pipe use, particularly in rural areas. Yet services to treat tobacco dependence are not readily available. The purpose of this study was to characterize current tobacco use treatment patterns among Vietnamese health care providers and factors influencing adherence to recommended guidelines for tobacco use screening and cessation interventions for water pipe, cigarette and dual users. Methods We conducted cross sectional surveys of 929 male current tobacco users immediately after they completed a primary care visit at one of 18 community health centers. Results Thirty-four percent of smokers used cigarettes only, 24% water pipe only, and 42% were dual users. Overall 12% of patients reported that a provider asked them if they used tobacco products during the visit. Providers were significantly more likely to screen cigarette smokers compared with water pipe or dual users (16%, 9% and 11% respectively). Similarly, 9% of current cigarette smokers received advice to quit compared to 6% of water pipe and 5% of dual users. No patients reported that their health care provider offered them assistance to quit (e.g., self-help materials, referral). Conclusion Despite ratifying the Framework Convention on Tobacco Control, Vietnam has not made progress in implementing policies and systems to ensure smokers are receiving evidence-based treatment. High rates of water pipe and dual use indicate a need for health care provider training and policy changes to facilitate treatment for both cigarette and water pipe use.

Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments—2015

Shelley, D., Feinberg, A., Lopez, P. M., Wyka, K., Islam, N., Seidl, L., Drackett, E., Mata, A., Pinzon, J., Baker, M. R., Lopez, J., Trinh-Shevrin, C., Shelley, D., Bailey, Z., Maybank, K. A., & Thorpe, L. E. (n.d.).

Publication year

2017

Journal title

Journal of Urban Health

Volume

94

Issue

4

Page(s)

525-533

10.1007/s11524-017-0180-z

Abstract

Abstract

To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.

System Changes to Implement the Joint Commission Tobacco Treatment (TOB) Performance Measures for Improving the Treatment of Tobacco Use Among Hospitalized Patients

Shelley, D., Goldfeld, K. S., Park, H., Mola, A., Sullivan, R., & Austrian, J. (n.d.).

Publication year

2017

Journal title

Joint Commission Journal on Quality and Patient Safety

Volume

43

Issue

5

Page(s)

234-240

10.1016/j.jcjq.2017.02.008

Abstract

Abstract

Background In 2012 The Joint Commission implemented new Tobacco Treatment (TOB) performance measures for hospitals. A study evaluated the impact of a hospital-based electronic health record (EHR) intervention on adherence to the revised TOB measures. Methods The study was conducted in two acute care hospitals in New York City. Data abstracted from the EHR were analyzed retrospectively from 4,871 smokers discharged between December 2012 and March 2015 to evaluate the impact of two interventions: an order set to prompt clinicians to prescribe pharmacotherapy and a nurse-delivered counseling module that automatically populated the nursing care plan for all smokers. The study estimated the relative odds of a patient being prescribed medication and/or receiving smoking cessation counseling in the intervention period compared to the baseline time period. Results There was a modest increase in medication orders (odds ratio [OR], 1.35). In contrast, rates of counseling increased 10-fold (OR, 10.54). Patients admitted through surgery were less likely to receive both counseling and medication compared with the medicine service. Conclusion Hospitalization presents an important opportunity to engage smokers in treatment for primary and secondary prevention of tobacco-related illnesses. EHRs can be leveraged to facilitate integration of TOB measure requirements into routine inpatient care; however, the smaller effect on prescribing patterns suggests limitations in this approach alone in changing clinician behavior to meet this measure. The success of the nurse-focused EHR–driven intervention suggests an effective tool for integrating the cessation counseling component of the new measures and the importance of nursing's role in achieving the Joint Commission measure targets.