As the state of Hawaiʻi responded to the COVID-19 pandemic in mid-March 2020, medical providers and community health centers shifted from in-person care to telehealth.  In rural communities on Hawaiʻi Island, moving medical appointments and health programs to telehealth, via internet and phone calls, created challenges as well as new opportunities to reach residents attempting to quit smoking and attain a healthier lifestyle.

Tobacco-Free Hawaiʻi Island coalition members who are trained Tobacco Treatment Specialists from the Hamakua-Kohala Health (HKH) Center, Bay Clinic and the Big Island Substance Abuse Council, shared how shifting to telehealth has impacted their programs.  According to the HKH’s tobacco cessation team­­, the HKH Center has been utilizing telehealth services since April 2019 via platforms such as LifeSize and most recently doxy.me.   Their tobacco cessation program had no interruption in conducting new enrollments and was able to continue care with existing patients via phone calls. New enrollments, follow ups and in-person visits continued when the stay-at-home order was lifted in June.  The availability of internet access for their patients was challenging, as cell service is limited along the Hamakua Coast. Despite the challenges, the tobacco cessation program staff was grateful to have the opportunity to offer telehealth, ensuring the lines of communication remained open.

Candee Rillon, Tobacco Treatment Specialist (TTS) for the Big Island Substance Abuse Council (BISAC) stated the effects of COVID-19 have been challenging, but has simultaneously created new opportunities for their tobacco cessation program. All of the treatment programs at BISAC: Substance Abuse Day treatment, Intensive Outpatient and Outpatient groups transitioned to an online group format.  BISAC is in the planning stages to reintegrate tobacco cessation programs into smaller in-person day treatment groups, and provide tobacco education via telehealth group format. 

According to Rillon, “Telehealth appears to be very suitable for one-on-one counseling sessions with the benefit of convenience for consumers to receive counseling services in the comfort and safety of their own homes.  TTS staff have noticed positive changes with regard to more people considering quitting due to the harmful effects of smoking and increased vulnerabilities of COVID-19”. “However,” Rillon continued, “Challenges for Substance Abuse Day consumers include staying fully engaged with the telehealth as these group settings are typically three hours long.” Another challenge for the Council is navigating how to streamline processes to complete necessary intake forms prior to the initial tobacco intervention.

Bay Clinic’s Tobacco Cessation Program team, Mari Martin and Judith Beaver, who serve Hilo, Puna and Kaʻu residents, shared how the pandemic has opened their hearts to see and hear an increase in fear among their clients of the virus and how being isolated is challenging their health and wellbeing. The Bay Clinic Smoking Cessation program uses telehealth in response to COVID-19 to continue to service clients and they are grateful to have this ability to reach clients. According to Martin and Beaver, many clients are nearly in tears as they feel the urgency to stop smoking immediately, coupled with their perceived weakness at not being able to stop immediately. Telehealth cannot replace the personal touch Bay Clinic’s Smoking Cessation Program staff have in face-to-face counseling, but they are making sure that their patients know they are doing everything they can to support them during this stressful time.

Rural areas have greater challenges due to the ‘digital divide’: lack of internet access and cell phone towers. Hawaiʻi County is dedicating CARES funds to create more mobile services access for our rural communities.  Our Tobacco-Free Hawaiʻi Island partners at HKH Health Center, BISAC and Bay Clinic are using telehealth to stay connected, expand new services and overcome the challenges of serving clients via telehealth. For more information regarding tobacco and e-cigarette cessation programs on Hawaiʻi Island, please contact our East Hawaiʻi Coordinator, Sally Ancheta at sally@hiphi.org and West Hawaiʻi Community Coordinator, Lisa DeSantis at lisa@hiphi.org.