Abstract B035: A qualitative analysis of organizational factors in readiness for change: Perceptions on implementation of a tobacco-free workplace program among staff working in healthcare settings serving rural and/or medically underserved areas of Texas

Abstract Background: Individuals with substance use disorders (SUDs) living in rural/medically underserved areas (MUAs) have high tobacco use rates and limited healthcare access, driving substantial cancer disparities (i.e., elevated risk, increased mortality). Provision of tobacco cessation care remains limited in rural/MUAs, underlining the need to implement evidence-based tobacco-free workplace programs (TFWPs) with comprehensive tobacco-free policies and cessation care in healthcare centers in these areas. Factors influencing the successful adoption of TFWPs require further scrutiny. According to organizational readiness for change (ORC) theory, perceived resource availability and staff valuing of change are key to adoption. To improve capacity for program uptake, this qualitative study examines staff perceptions of resource availability and perceived value for adopting a TFWP within healthcare centers serving rural/MUAs in Texas to prevent tobacco-related cancers. Methods: We analyzed 16 virtual semi-structured group interviews lasting ∼50 minutes with 70 providers and 15 managers. Conducted prior to implementing a TWFP, interviews focused on attitudes toward TFWP adoption in 12 healthcare centers in rural/MUAs in Texas serving ≥90,000 unique patients yearly in 93 counties. Rapid qualitative analysis was used to formulate key domains drawn from interview guides to summarize and organize data into matrices. To ensure analytic rigor, 2 qualified analysts independently summarized data. Guided by the ORC theory, analysts systematically compared and synthesized findings across domains to develop themes during final analysis. Results: Analysis yielded 4 key themes: 1) Efficacy: additional training and resources are needed to build further capacity–staff reported lack of training and resources hindered their provision of tobacco dependence care and were open to integrating additional cessation services into practice; 2) Contextual factors: limited institutional frameworks, policies, and practices–current institutional supports for adopting tobacco-free policies and delivering cessation services were minimal; 3) Valuing: tobacco cessation was valued as compatible but not a priority–patients have multiple contending needs that take precedence; and 4) Conflicting attitudes: negative assumptions about patient tobacco use and smoking to maintain sobriety–staff perception of low patient desire to quit and that tobacco use is needed to sustain their non-nicotine SUD recovery limited cessation care provision. Conclusion: Findings emphasize the need for organizational change to build tobacco cessation infrastructure and reduce tobacco-related cancer disparities via targeted interventions, inclusive of training, resources, and education on how treating tobacco use supports SUD recovery. This work contributes insights into using pre-implementation processes to assess partner needs, as well as identifies enablers and barriers affecting uptake of TFWPs, within healthcare centers in disparity settings to enhance program engagement, capacity, adoption, and sustainment. Citation Format: Abigail E. Bergey, Isabel Martinez Leal, Maggie Britton, Hannah Wani, Asfand B. Moosa, Tzuan A. Chen, Tarik D. Goulbourne, Ammar D. Siddiqi, Teresa Williams, Kathleen Casey, Lorraine R. Reitzel. A qualitative analysis of organizational factors in readiness for change: Perceptions on implementation of a tobacco-free workplace program among staff working in healthcare settings serving rural and/or medically underserved areas of Texas abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B035.