Integrating Motivational Interviewing Into a Home Telehealth Program for Veterans With Posttraumatic Stress Disorder Who Smoke: A Randomized Controlled Trial.

OBJECTIVE: We evaluated integrating a motivational interviewing (MI)-based smoking cessation curricula and MI counseling into a posttraumatic stress disorder (PTSD) home telehealth care management program to determine if smoking behaviors improved. METHOD: We randomized 178 Veterans with PTSD to a 90-session MI-based home telehealth program or to usual care. Outcome measures included self-reported 24-hour quit attempts, seven-day point prevalence abstinence, progression along the stages of change, and mental health symptoms. RESULTS: Favorable smoking cessation rates were observed in both groups. There was no statistical difference in self-reported 24-hour quit attempts, seven-day point prevalence smoking abstinence or progression along the stages of change. The intervention group showed improved depression and PTSD symptoms. CONCLUSION: Integrating MI-based smoking cessation treatment into PTSD home telehealth is an effective method to help Veterans with PTSD quit smoking. Further research is needed to understand how to optimize MI integration into home telehealth to achieve sustained smoking cessation rates.

Building a tobacco cessation telehealth care management program for veterans with posttraumatic stress disorder.

BACKGROUND: Veterans with posttraumatic stress disorder (PTSD) have high rates of smoking. Motivational interviewing (MI) enhances readiness for change. OBJECTIVE: To test the feasibility and fidelity of home telehealth care management strategy to improve quit rates. DESIGN: A telehealth device delivered a cessation curriculum while a nurse supported veterans through weekly MI telephone calls. Treatment fidelity was evaluated. Outcomes measures included changes in smoking behaviors, stage of change, dose effect, and participant satisfaction with intervention. RESULTS: There was a correlation (r = -.677; p = .03) at the end of treatment between readiness to change and number of cigarettes smoked per day. As 11 participants progressed along stages of change, they smoked fewer cigarettes per day. Two (20%) quit smoking. The nurse adhered to MI principles. Participants were highly satisfied and 100% felt curriculum delivered new information and respected choices. CONCLUSIONS: It was feasible to deliver the home telehealth care management intervention with high treatment fidelity. Participants were motivated to change smoking behaviors.