Understanding people who smoke and how they change: a foundation for smoking cessation in primary care, part 1

Impact of tobacco cessation education on behaviors of nursing undergraduates in helping smokers to quit smoking

INTRODUCTION

Smoking continues to be a significant public health issue, but nursing students do not receive sufficient training on tobacco cessation education. Integrating the 5As behaviors for tobacco cessation into a compulsory course could improve nursing students’ skills and increase their clinical behaviors for assisting patients in quitting smoking. The aim of this study was to evaluate the impact of evidence-based tobacco cessation education on the perceptions and behaviors of nursing students who are assisting patients to quit smoking.

METHODS

A prospective single-group design was used to evaluate the perceptions and behaviors of 626 senior nursing students enrolled in an education program, at three time points: baseline, 3 months post education, and 6 months post education. Data were collected, before and after the tobacco cessation education, using assessment tools for knowledge, attitudes, and the 5As behaviors for assisting patients to quit smoking.

RESULTS

A total of 572 senior students completed the baseline survey, 289 students completed the survey 3 months post education, 348 students completed the survey 6 months post education, and 285 students completed all three surveys. Knowledge and self-efficacy of tobacco cessation were improved dramatically (p<0.05) after the education program, compared with the baseline survey. At 6 months post education, compared with at 3 months post education, nursing students reported more interventions of asking, advising, assessing, assisting, and arranging smokers to quit smoking (p<0.05).

CONCLUSIONS

The integration of tobacco cessation education into compulsory courses could improve clinical skills and enhance the behaviors of nursing students for assisting patients to quit smoking.

Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care

BACKGROUND

Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before.

OBJECTIVE

The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke.

METHODS

A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population.

RESULTS

Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose.

CONCLUSIONS

Subject matter experts, although generally amenable to one another's disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building.

Outcome of a four-hour smoking cessation counselling workshop for medical students

Background

Lack of smoking cessation education in undergraduate medical training hinders healthcare professionals in providing adequate tobacco cessation counselling.

We developed a comprehensive 4-h smoking cessation counselling course for medical students that is easy to incorporate in a medical school curriculum, and assessed its short-term outcome for knowledge, skills, and attitudes.

Methods

Eighty-eight medical students (53f, 35 m) were educated by a doctoral student in five identical 4-h courses. A 45-min theoretical introduction was followed by patient-physician role-playing by student pairs. Knowledge, skills, and attitude were assessed before and 4 weeks after the course by questionnaires, and by blinded analysis of pre- and post-course videos of a five-minute standardized patient situation.

Results

Knowledge: Before the course 10.6 (mean, SD: 2.7) questions out of 29 were answered correctly, and increased to 19.2 (3.6) after the course (p < 0.0005). Major features of the students’ counselling skills improved. Significant and highly relevant attitude changes reflected increased motivation to counselling smokers.

Conclusion

Implementing a four-hour smoking intervention workshop into a medical curriculum was highly effective in improving students’ knowledge, skills and attitudes towards smoking counselling, as well as providing them with additional clinical competencies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12971-016-0103-x) contains supplementary material, which is available to authorized users.

Transtheoretical model of health behavior change applied to voice therapy

Studies of patient adherence to health behavior programs, such as physical exercise, smoking cessation, and diet, have resulted in the formulation and validation of the Transtheoretical Model (TTM) of behavior change. Although widely accepted as a guide for the development of health behavior interventions, this model has not been applied to vocal rehabilitation. Because resolution of vocal difficulties frequently depends on a patient's ability to make changes in vocal and health behaviors, the TTM may be a useful way to conceptualize voice behavior change processes, including the patient's readiness for change. The purpose of this paper is to apply the TTM to the voice therapy process to: (1) provide an organizing framework for understanding of behavior change in voice therapy, (2) explain how treatment adherence problems can arise, and (3) provide broad strategies to improve treatment adherence. Given the significant role of treatment adherence in treatment outcome, considering readiness for behavior change should be taken into account when planning treatment. Principles of health behavior change can aid speech pathologists in such understanding and estimating readiness for voice therapy.