Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Julianne Ossege

Clinical Mentor

Dr. Julie Wolford

Committee Member

Dr. Lynne Jensen

Committee Member

Dr. Chizimuzo Okoli



Background: Tobacco use in the United States is the chief cause of preventable disease and death. Preventing and identifying tobacco use through screening and education is essential to assist users to quit and to decrease overall tobacco associated health risks.

Purpose: The purpose of this study was to assess the integration of the 5A’s tobacco engagement framework into the workflow at one Primary Care Center. Study objectives included determining baseline tobacco screening data prior to 5A’s education, providing providers and support staff education on the 5A’s process, reviewing and interpreting pre/post data of the 5A’s process, and identification of barriers to using the 5A’s process.

Methods: This was a descriptive two-phase study. Providers and support staff were educated on implementing the 5A’s framework. Retrospective chart reviews included pre and post data.

Results: The chart reviews pre and post-implementation included 100 patients each. There was no significant difference in age (p=.22), race/ethnicity (p=.86), between the pre and post intervention samples. Twenty-five percent of the pre-implementation sample were current tobacco users compared to 44% tobacco user’s post-implementation (p=.01). Among the tobacco users, there was no significant difference noted between documentation in the problem list (p=.67), provider note (p=.98), or cessation plan documentation within the provider note (p=.27) pre or post-implementation. Post-implementation chart reviews only identified 2 completed 5A’s forms. Due to insufficient use of the 5A’s tool, data analysis and interpretation related to implementation of the newly introduced tool was contraindicated. An additional report identified that 11 total 5A’s forms were completed and scanned into the electronic medical record correctly over the 3-month study period. Furthermore, 10 out of 11 (91%) of the 5A’s forms retrieved had all the 5A’s components completed.

Conclusion: Due to several barriers and limitations including time constraints and lack of provider familiarity with the 5A’s framework, the 5A’s were not routinely utilized by providers during the implementation period. Organizational support and additional provider education are needed prior to integrating the 5A’s into the primary care workflow. Additional studies are needed to assess health outcomes related to the 5A’s intervention tool.