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Najdi J, Hawa ME, El-Achkar A, Naji N, Telvizian T, Romani M, Hajj AE, Mukherji D. Smoking cessation counselling patterns in cancer patients - survey of Lebanese physicians. Ecancermedicalscience 2024; 18:1699. [PMID: 38774569 PMCID: PMC11108051 DOI: 10.3332/ecancer.2024.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Tobacco smoking is a known risk factor for cancer development and smoking cessation can lower this risk and improve outcomes in some cancer patients. Despite that, many cancer patients do not quit smoking after a cancer diagnosis, and smoking cessation counselling is still not routinely provided in cancer care. The aim of this study is to examine patterns in smoking cessation counselling to cancer patients by their treating physicians. Methods A self-administered, web-based (mobile-friendly), anonymous questionnaire was developed on LimeSurvey and sent by e-mail to Lebanese physicians of different specialties between June 2020 and January 2022. Data were analysed using SPSS and associations between the different items were determined using the χ2 test. Results A total of 146 physicians filled out the questionnaire. Almost all physicians ask cancer patients about their smoking status, but only 45.9% provide smoking cessation counselling, and only 24% refer patients to smoking cessation counselling programs. Only 27.4% of all respondents have received formal smoking cessation training, and only 27.4% feel capable of providing smoking cessation counselling in their clinic. Specifically, family medicine physicians were more likely to provide smoking cessation counselling in the clinic (69%), more likely to refer patients to a smoking cessation counselling program (44%), and more likely to have received formal smoking cessation counselling training (67%) and more likely to feel capable of providing smoking cessation counselling (93%). Lack of training, lack of knowledge of available programs and the lack of availability of enough programs are leading obstacles contributing to low rates of smoking cessation counselling in cancer patients as reported by the physicians. Conclusion Our data reveals a deficiency in smoking cessation counselling and referral of cancer patients to smoking cessation counselling programs in our region. This highlights the need for dedicated smoking cessation counselling training for practicing physicians and physicians in training.
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Affiliation(s)
- Jad Najdi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0001-6224-894X
| | - Mariana El Hawa
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adnan El-Achkar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0002-3656-4217
| | - Nour Naji
- Department of Hematology and Oncology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
- https://orcid.org/0009-0004-4761-7435
| | - Talar Telvizian
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
- https://orcid.org/0000-0002-6407-6501
| | - Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0001-5437-0128
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0002-0043-7195
| | - Deborah Mukherji
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0002-3635-0083
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Moeteke NS, Oyibo P, Ochei O, Ntaji MI, Awunor NS, Adeyemi MO, Enemuwe IM, Agbatutu E, Adesoye OO. Effectiveness of online training in improving primary care doctors' competency in brief tobacco interventions: A cluster-randomized controlled trial of WHO modules in Delta State, Nigeria. PLoS One 2024; 19:e0292027. [PMID: 38386654 PMCID: PMC10883549 DOI: 10.1371/journal.pone.0292027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) strongly recommends that brief tobacco interventions should be routinely offered in primary care. However, medical doctors do not consistently and effectively intervene during their encounters with cigarette smokers. There is a paucity of studies assessing the effect of training on the tobacco intervention competency of primary care doctors in Nigeria. AIM To evaluate the effectiveness of online training in improving competency in brief tobacco interventions among primary care doctors in Delta State, Nigeria. METHODS A cluster-randomized controlled trial was conducted among eligible doctors working in government-owned facilities. The 22 eligible Local Government Areas (LGAs) served as clusters. The intervention group received a WHO six-hour online course on brief tobacco cessation intervention, delivered via Zoom. The control group received no intervention. A structured questionnaire was sent to participants via WhatsApp before and six months after the training. The primary outcome variables were scores for knowledge, attitude, self-efficacy, and practice. Differences in change of scores between intervention and control groups were assessed with t-test. To adjust for clustering, these inter-group differences were further analyzed using linear mixed-effects regression modeling with study condition modeled as a fixed effect, and LGA of practice entered as a random effect. RESULTS The intervention group had a significantly higher mean of change in scores for knowledge (effect size 0.344) and confidence (effect size 0.52). CONCLUSION The study shows that training, even online, positively affects clinician competency in brief tobacco intervention. This is important for primary care systems in developing countries. Mandatory in-service training and promotion of the WHO modules are recommended.
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Affiliation(s)
- Nnamdi Stephen Moeteke
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Center for Primary Care, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Patrick Oyibo
- Department of Health Services Research and Management, City, University of London, London, United Kingdom
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Oboratare Ochei
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Maureen Iru Ntaji
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Nyemike Simeon Awunor
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | | | - Ibobo Mike Enemuwe
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Eseoghene Agbatutu
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Oluwaseun Opeyemi Adesoye
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
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Westmaas JL, Kates I, Makaroff L, Henson R. Barriers to helping patients quit smoking: Lack of knowledge about cessation methods, E-cigarettes, and why nurse practitioners and physician assistants can help. PUBLIC HEALTH IN PRACTICE 2023; 6:100409. [PMID: 37554288 PMCID: PMC10405087 DOI: 10.1016/j.puhip.2023.100409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/06/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES Health care settings are ideal for addressing patients' smoking and quitting, but barriers may limit providers' assistance with cessation, including lack of knowledge about newer devices being used by some smokers to quit (e.g., e-cigarettes). Cessation practices among nurse practitioners (NPs) and physician assistants (PAs) are also unknown. STUDY DESIGN Cross-sectional. METHODS Participants (N = 459) were 151 oncologists, 150 primary care physicians (PCPs), 98 nurse practitioners (NPs), and 60 physician assistants (PAs) recruited from a national online panel who completed an online survey. RESULTS Four barriers were common across specialties: "patient doesn't want to quit, and it is their decision," "smoking is not reason for patient's visit; must treat the immediate problem first," "patient wants to quit on their own," and "lack of effective methods available." While a majority of oncologists (58%) were aware of free telephone counseling for cessation, only 29% of NPs were aware. Perceived knowledge of e-cigarettes was low. Greater comfort treating patients' smoking predicted greater frequency of engagement in 4 of 5 general cessation practices (βs = 0.15-0.26, all p ≤ .001). NPs and PAs more frequently asked patients about smoking and e-cigarette use compared to oncologists, but oncologists more frequently referred patients to effective quitting resources (e.g., quitlines). CONCLUSIONS NPs and PAs may be uniquely positioned to provide cessation assistance, but providers need more education on currently available, effective cessation methods, and about e-cigarettes. Addressing patient resistance to offers of cessation services and improving clinical workflows to enhance cessation service provision should be investigated in future research.
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Affiliation(s)
- J. Lee Westmaas
- American Cancer Society, 250 Williams St. NW, Atlanta, GA, 30312, USA
| | | | - Laura Makaroff
- American Cancer Society, 250 Williams St. NW, Atlanta, GA, 30312, USA
| | - Rosie Henson
- Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
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4
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Stephenson R, Lesco G, Babii V, Luchian A, Bakunina N, De Vasconcelos AS, Blondeel K, Cáceres CF, Pitter RA, Metheny N, Goldenberg T, Kiarie J, Toskin I. Provider attitudes towards a brief behavioral intervention for sexual health in Moldova. BMC Public Health 2021; 21:1469. [PMID: 34320985 PMCID: PMC8317477 DOI: 10.1186/s12889-021-11490-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Brief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation. Methods Thirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts. Results Providers largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention. Conclusions While providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases.
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Affiliation(s)
- Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, USA. .,Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA.
| | - Galina Lesco
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Viorel Babii
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Andrei Luchian
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Nataliia Bakunina
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ana Sofia De Vasconcelos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Renée A Pitter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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5
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Does Medication Sampling Improve Compliance with Brief Advice? Results from a Pragmatic Randomized Clinical Trial. J Smok Cessat 2021; 2021. [PMID: 33828613 PMCID: PMC8023690 DOI: 10.1155/2021/6638872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction The 5As model is a standard component of most guidelines for tobacco treatment. Unfortunately, provider adherence to this model is modest. Aims Providing physicians with adjunctive tools to adhere to 5As guidelines may serve as a catalyst for brief advice delivery. Methods This was a secondary data analysis of a cluster randomized clinical trial assessing the uptake and impact of free nicotine replacement therapy (NRT) sampling versus standard care in primary care. Patients reported receipt of separate elements of the 5As model, assessed one month following a baseline visit. Analyses compared patients who recalled receipt of brief advice among those who received NRT vs. standard care. Additional analyses examined demographic predictors of receiving brief advice. Results/Findings. Medication sampling did not improve compliance with ask, advise, or assess. Receipt of “assistance” was significantly higher among NRT recipients (70%) (p ≤ 0.0001). The NRT sampling group was more likely to have received all components (p = 0.004). As age increased, being asked (p = 0.006), advised (p = 0.05), and assessed (p = 0.003) decreased. Non-Whites reported higher rates of assessment (p = 0.02). Conclusions Provision of NRT sampling increased provider compliance with some elements of the brief advice model, thus enhancing the impact of cessation advice within primary care. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02096029.
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Kazan AS, Perry LM, Atiya WF, Voss HM, Kim S, Easwar S, Mercorella HN, Lewson A, Rogers JL, Arnold D, Raines AM, Brown L, Moore T, Hoerger M. Development and acceptability of an educational video about a smoking cessation quitline for use in adult outpatient mental healthcare. Transl Behav Med 2021; 11:1579-1584. [PMID: 33647990 DOI: 10.1093/tbm/ibaa145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tobacco use is a leading preventable cause of early mortality and is prevalent among adults with mental health diagnoses, especially in the southern USA. Increasing cessation resources in outpatient mental health care and targeting individuals most receptive to changing their behavior may improve cessation. Drawing on the transtheoretical model, our goals were to develop an educational video about the Louisiana Tobacco Quitline and evaluate its acceptability. We designed the video with knowledge derived from Louisiana-specific data (2016 Louisiana Adult Tobacco Survey, N = 6,469) and stakeholder feedback. Bivariate associations between demographic/tobacco-use characteristics and participants' stage of quitting (preparation phase vs. nonpreparation phase) were conducted, which informed design elements of the video. Four stakeholder advisory board meetings involving current smokers, mental health clinicians, and public health advocates convened to provide iterative feedback on the intervention. Our stakeholder advisory board (n = 10) and external stakeholders (n = 20) evaluated intervention acceptability. We found that 17.9% of Louisiana adults were current smokers, with 46.9% of them in the preparation phase of quitting. Using insights from data and stakeholders, we succeeded in producing a 2-min video about the Louisiana Tobacco Quitline which incorporated three themes identified as important by stakeholders: positivity, relatability, and approachability. Supporting acceptability, 96.7% of stakeholders rated the video as helpful and engaging. This study demonstrates the acceptability of combining theory, existing data, and iterative stakeholder feedback to develop a quitline educational video. Future research should examine whether the video can be used to reduce tobacco use.
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Affiliation(s)
- Adina S Kazan
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Wasef F Atiya
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Hallie M Voss
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Seowoo Kim
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Sanjana Easwar
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Hannah N Mercorella
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Ashley Lewson
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - James L Rogers
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Dodie Arnold
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.,School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Lisanne Brown
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Tonia Moore
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA, USA.,Tulane Cancer Center, Tulane University, New Orleans, LA, USA
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Karacabeyli D, Shojania K, Dehghan N, Lacaille D. Rheumatology health care providers' views and practices on obesity and smoking cessation management in rheumatoid arthritis. Clin Rheumatol 2021; 40:2681-2688. [PMID: 33517485 DOI: 10.1007/s10067-021-05607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess rheumatology health care providers' (HCPs) knowledge, beliefs, self-efficacy, practices, and perceived barriers pertaining to weight management and smoking cessation counselling in patients with rheumatoid arthritis (RA). METHOD We administered an online survey to collect self-reported data on rheumatology HCPs' knowledge, beliefs, self-efficacy, perceived barriers, and practices related to weight management and smoking cessation counselling. Participants were recruited through invitation emails (with anonymous survey links) sent by three Canadian rheumatology organizations. RESULTS Fifty-nine rheumatology HCPs (15 nurses, 44 physicians) completed the survey (response rate: 11%). Over 85% correctly identified associations between obesity, or smoking, and more severe or active RA, as well as poorer response to treatment. All but one participant agreed that it was part of their responsibility to discuss these issues with patients, but 78% (46/59) felt not or slightly confident in their ability to help patients quit smoking or achieve clinically significant weight loss. The majority did not routinely assist patients in accessing appropriate resources or providers (only 42% did for obesity, 36% for smoking), send referrals (2-44%, depending on referral), or offer relevant educational materials (15% for obesity, 20% for smoking). Common barriers included competing demands and lack of time, training, access to expertise, and knowledge of available programs. CONCLUSION Most rheumatology HCPs understood the implications of cigarette smoking and obesity in RA and accepted responsibility in addressing these issues. However, they lacked the time, training, confidence, and knowledge of local resources to do so effectively. There is a need to bridge this gap. Key Points • Training through medical and nursing school as well as residency on weight management and smoking cessation counselling was nearly unanimously described as poor or fair. • Most rheumatology health care providers understood the implications of cigarette smoking and obesity in rheumatoid arthritis and accepted responsibility in addressing these issues; however, they lacked the time, training, confidence, and knowledge of local resources to do so effectively. • There is a need to bridge the gap between health care providers' intentions and actions, and this may include the development of guides outlining local weight management and smoking cessation expertise, programs, referral processes, and educational materials.
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Affiliation(s)
- Derin Karacabeyli
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kam Shojania
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, 5591 Number 3 Rd, Richmond, British Columbia, BC V6X 2C7, Canada
| | - Natasha Dehghan
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, 5591 Number 3 Rd, Richmond, British Columbia, BC V6X 2C7, Canada
| | - Diane Lacaille
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. .,Arthritis Research Canada, 5591 Number 3 Rd, Richmond, British Columbia, BC V6X 2C7, Canada.
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Thomas K, Bendtsen M, Linderoth C, Bendtsen P. Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients' and Health Care Professionals' Perspectives. JMIR Mhealth Uhealth 2020; 8:e17563. [PMID: 32945772 PMCID: PMC7532460 DOI: 10.2196/17563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/23/2020] [Accepted: 06/16/2020] [Indexed: 01/11/2023] Open
Abstract
Background There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients. Objective This study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery. Methods A qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data. Results Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium. Conclusions Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery.
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Affiliation(s)
- Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Catharina Linderoth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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9
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Malin M, Jaakkola N, Luukkonen R, Heloma A, Lamminpää A, Reijula K. Occupational health professionals' attitudes, knowledge, and motivation concerning smoking cessation-Cross-sectional survey. J Occup Health 2020; 62:e12145. [PMID: 32701202 PMCID: PMC7377039 DOI: 10.1002/1348-9585.12145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Occupational health (OH) professionals could play a prominent role in smoking cessation treatment and support (SCTS) and help individuals and workplaces become smoke free. However, their role has not been evaluated. The aim of this study was to assess differences between OH professionals' perceptions of their role in SCTS by measuring three groups of OH professionals' attitudes, knowledge, and motivation concerning SCTS. METHODS We collected data through an online survey completed by a cross-sectional sample of OH professionals: OH physicians (n = 182), OH nurses (n = 296), and OH physiotherapists (n = 96), collected from national trade union registers. The differences between the OH professional groups were analyzed using ANOVA, the Kruskal-Wallis, and chi-square tests. RESULTS The OH professionals had a positive attitude toward offering SCTS and were highly motivated to enhance their knowledge of this topic and acquire further training. The OH physicians and OH nurses assessed their current knowledge as sufficient. Conversely, the OH physiotherapists' level of knowledge was seen as insufficient. Traditionally, OH physicians and OH nurses have been responsible for carrying out SCTS, but the majority of the OH physiotherapists thought that SCTS should also be included in their job description. CONCLUSIONS All the OH professionals were highly motivated to deepen their knowledge of SCTS. The barriers between different professionals need to be recognized in occupational health services (OHS). OHS should organize its SCTS more effectively, strengthen their contributions to smoking cessation programs, and recognize the potential of OH physiotherapists for providing SCTS and enable them to expand their training.
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Affiliation(s)
- Maarit Malin
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Nina Jaakkola
- The Social Insurance Institution of FinlandHelsinkiFinland
| | - Ritva Luukkonen
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Antero Heloma
- National Institute for Health and WelfareHelsinkiFinland
| | - Anne Lamminpää
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Kari Reijula
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
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10
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Coovadia S, D'Alimonte L, Bristow B, Curle E, Gibson L, Di Prospero L. Catalyst for Change: Measuring the Effectiveness of Training of All Health Care Professionals to Provide Brief Intervention for Smoking Cessation to Cancer Patients. J Med Imaging Radiat Sci 2019; 51:7-11. [PMID: 31864933 DOI: 10.1016/j.jmir.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Smoking cessation is recommended to prevent individuals from developing cancer, with additional benefits after a cancer diagnosis. Tobacco use during cancer treatments increases the risk of complications and may reduce the effectiveness of treatment; patients who quit smoking are less likely to experience recurrence. Health care professionals play a vital role in assessing and educating cancer patients on how to quit. We report on the effectiveness of peer-to-peer education of a brief smoking cessation intervention to patients. METHODS An interprofessional team was created to implement and integrate smoking cessation best practices into daily clinical care. Health care providers were provided with peer-to-peer training to provide brief interventions of smoking cessation to patients. After training, participants were invited to complete an electronic survey to assess the effectiveness of the peer-to-peer training sessions. The survey consisted of 3 domains: confidence, comfort, and knowledge. Participants were asked to rate a series of statement questions using a Likert scale as well as to self-assess knowledge. The survey also included open-ended questions to invite respondents to share further comments and feedback. RESULTS Approximately 90% of staff across the oncology program participated in a training session. This included nurses, radiation therapists, and patient and family support professionals. Sixty-one surveys were returned (30% response rate). Most respondents had >10 years of clinical experience (70%), 91% agreed it was important to support patients in their efforts to quit smoking, 88% agreed they have an impact on their patients' smoking cessation attempts, and 67% had opportunities in daily practice to support smoking cessation. Sixty-one percent would benefit from additional education. Fifty-three percent indicated they experienced challenges providing interventions and patients' responsiveness to the intervention. CONCLUSIONS Peer-to-peer training for smoking cessation can increase confidence, comfort, and knowledge. Challenges include comfort level of clinician, determining the best time to ask patients, and having the confidence in knowing their scope of practice.
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Affiliation(s)
- Sadiya Coovadia
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laura D'Alimonte
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Nursing, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bonnie Bristow
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Elaine Curle
- Department of Patient and Family Support, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Leslie Gibson
- Practice-based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Department of Nursing, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Hasan SI, Mohd Hairi F, Amer Nordin AS, Danaee M. Development and Validation of an Evaluation Tool to Measure the Effectiveness of a Smoking Cessation Training among Healthcare Providers in Malaysia: The Providers' Smoking Cessation Training Evaluation (ProSCiTE). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4297. [PMID: 31694286 PMCID: PMC6862003 DOI: 10.3390/ijerph16214297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022]
Abstract
Background: In line with Article 14 of the Framework Convention for Tobacco Control, we have witnessed vast developments in smoking cessation training for healthcare providers, offering help for smokers. However, there is no specific evaluation tool to monitor and evaluate the effectiveness of these programs for future enhancement and sustainability. Objective: To develop and validate a new tool for evaluating smoking cessation training programs for healthcare providers called the Providers' Smoking Cessation Training Evaluation (ProSCiTE). Methods: The 74-item ProSCiTE tool was developed based on a review of the literature and an expert panel review. The tool was validated in a sample of 403 healthcare providers using a cross-sectional study design from July to December 2016. Content validity was assessed by the Scale-Content Validity Index (S-CVI). The construct validity of the ProSCiTE was analyzed using exploratory factor analysis (EFA) to confirm psychometric properties. Internal consistency reliability was determined using Cronbach's alpha. Results: The content validity showed that the S-CVI ranged from 0.82 to 1.00 for consistency, representativeness, relevancy, and the clarity of each construct, resulting in 67 items for the questionnaire. The construct validity of the ProSCiTE (based on eigenvalues and factor loadings to confirm the four-factor structure (attitude, self-efficacy, behavior, and barriers) with 54.74% total variance) was acceptable (Kaiser-Mayer-Olkin = 0.923; Bartlett's test of sphericity was significant, p < 0.001). The internal consistency reliability of the four-factor structure was very good, with Cronbach's alpha values at 0.89, 0.94, 0.95, and 0.90, respectively. Conclusions: This study showed that 67 items of the ProSCiTE demonstrated good content and construct validity, as well as a high internal consistency reliability for the measurement of knowledge, attitudes, self-efficacy, behavior, and barriers to smoking cessation interventions among healthcare providers. Therefore, the ProSCiTE is a valid and reliable research tool with which to evaluate the effectiveness of smoking cessation training programs.
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Affiliation(s)
- Siti Idayu Hasan
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia; (S.I.H.); (M.D.)
- Nicotine Addiction Research Group UMCAS, Wisma R & D University of Malaya, Jalan Pantai Baharu, 59200 Kuala Lumpur, Malaysia;
| | - Farizah Mohd Hairi
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia; (S.I.H.); (M.D.)
- Nicotine Addiction Research Group UMCAS, Wisma R & D University of Malaya, Jalan Pantai Baharu, 59200 Kuala Lumpur, Malaysia;
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research Group UMCAS, Wisma R & D University of Malaya, Jalan Pantai Baharu, 59200 Kuala Lumpur, Malaysia;
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia; (S.I.H.); (M.D.)
- Nicotine Addiction Research Group UMCAS, Wisma R & D University of Malaya, Jalan Pantai Baharu, 59200 Kuala Lumpur, Malaysia;
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Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers. BMC Health Serv Res 2019; 19:750. [PMID: 31653215 PMCID: PMC6815021 DOI: 10.1186/s12913-019-4527-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer. Methods Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses. Results The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes. Conclusions There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.
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Hasan SI, Mohd Hairi F, Ahmad Tajuddin NA, Amer Nordin AS. Empowering healthcare providers through smoking cessation training in Malaysia: a preintervention and postintervention evaluation on the improvement of knowledge, attitude and self-efficacy. BMJ Open 2019; 9:e030670. [PMID: 31562154 PMCID: PMC6773327 DOI: 10.1136/bmjopen-2019-030670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Healthcare providers are ideally positioned to advise their patients to quit smoking by providing effective smoking cessation intervention. Thus, we evaluate the effectiveness of a 1-day training programme in changing the knowledge, attitude and self-efficacy of healthcare providers in smoking cessation intervention. METHODS A prepost study design was conducted in 2017. The 8-hour Smoking Cessation Organising, Planning and Execution (SCOPE) training comprised lectures, practical sessions and role-play sessions to 218 healthcare providers. A validated evaluation tool, Providers' Smoking Cessation Training Evaluation, was administered to assess the impact of training on knowledge, attitude and self-efficacy on smoking cessation intervention. RESULTS After SCOPE training, the knowledge score increased significantly from 7.96±2.34 to 10.35±1.57 (p<0.001). Attitude and self-efficacy in smoking cessation intervention also increased significantly from 34.32±4.12 to 37.04±3.92 (p<0.001) and 40.31±8.61 to 54.67±7.45 (p<0.001) respectively. Pretraining and post-training scores improved significantly for all professions, and each measure, particularly self-efficacy. CONCLUSION This study demonstrates that SCOPE training could improve healthcare providers' knowledge, attitude and self-efficacy on smoking cessation intervention. Future training is recommended to equip healthcare providers with current knowledge, positive attitude and high self-efficacy to integrate what they have learned into practice successfully.
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Affiliation(s)
- Siti Idayu Hasan
- Social & Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
| | - Farizah Mohd Hairi
- Social & Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
- Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
- Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Meijer E, van der Kleij R, Segaar D, Chavannes N. Determinants of providing smoking cessation care in five groups of healthcare professionals: A cross-sectional comparison. PATIENT EDUCATION AND COUNSELING 2019; 102:1140-1149. [PMID: 30718091 DOI: 10.1016/j.pec.2019.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
Objective To investigate implementation of a tobacco dependence treatment guideline among five groups of healthcare professionals. Methods Data collected in The Netherlands (2016-2017) were compared among gynaecologists (N = 49), midwives (N = 68), respiratory nurses (N = 72), practice nurses (N = 84) and paediatricians (N = 38). Intentions to use the guideline, satisfaction with own implementation, and dosage delivered of quit-advice and assisting in quitting were predicted using linear regression analyses and regression tree analyses. Results Implementation of smoking cessation care (SCC) and barriers differed between the groups, with nurses reporting better implementation and fewer barriers. Main barriers were lacking training (gynecologists, pediatricians) and time (midwives). Regression tree analyses showed that self-efficacy and training interacted; participants with weaker self-efficacy provided more quit advice if they had participated in SCC training. Training was positively related to intentions to use the guideline, satisfaction, providing quit-advice, and assisting smokers in quitting. Conclusion Implementation of SCC is suboptimal, such that patients who smoke do not receive the highest quality of care. Profession and training in SCC are important determinants of implementation of SCC. Practice implications Efforts to improve implementation should be targeted at profession. Training is indicated, and may focus on skills for nurses, and knowledge for gynecologists, midwives and pediatricians.
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Affiliation(s)
- Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Rianne van der Kleij
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Dewi Segaar
- Dutch Alliance for a Smokefree Society, Utrecht, the Netherlands
| | - Niels Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Brown EM, Hayes KA, Olson LT, Battles H, Ortega-Peluso C. Dentist and hygienist smoking cessation counseling and awareness of Medicaid benefits. J Public Health Dent 2019; 79:246-252. [PMID: 31063236 DOI: 10.1111/jphd.12321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/11/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Integrating smoking cessation interventions into dental care is an efficient way to intervene with smokers. This study of dentists and dental hygienists who provide dental care to Medicaid-insured patients explores awareness of Medicaid smoking cessation benefits, awareness of Quitline resources, beliefs about perceived role in providing tobacco interventions, and behaviors around clinical intervention. METHODS In 2015, we conducted a survey of dentists and hygienists who serve Medicaid patients in New York State. RESULTS A total of 182 dentists and 92 hygienists completed the survey. Ninety percent reported that helping patients quit smoking is part of their role, while 51.0 percent reported feeling confident in their ability to counsel a patient about quitting. Most respondents (73.4 percent) asked patients about tobacco use, 83.7 percent advised smokers to quit, and 49.1 percent assisted with quit attempts. We found that 26.7 percent were aware that dentist smoking cessation counseling is covered by Medicaid, and 15.5 percent were aware that hygienist smoking cessation counseling is covered. A total of 38.9 percent were aware of any Medicaid coverage for smoking cessation. Awareness of the Medicaid smoking cessation benefit was associated with intervention behaviors of asking and assisting. CONCLUSIONS Most dental care providers see smoking cessation as part of their role, but few are aware of the Medicaid benefits available to help patients. Expanding coverage of and promoting Medicaid benefits for smoking cessation have the potential to increase the reach and quality of smoking cessation interventions for Medicaid-insured smokers, a population disproportionately affected by tobacco use.
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Affiliation(s)
- Elizabeth M Brown
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Kim A Hayes
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Lindsay T Olson
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Haven Battles
- Division of Chronic Disease Prevention, New York State Department of Health, Albany, NY, USA
| | - Christina Ortega-Peluso
- Division of Chronic Disease Prevention, New York State Department of Health, Albany, NY, USA
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Matouq A, Khader Y, Khader A, Al-Rabadi A, Al Omari M, Iblan I, Al-Sheyab N. Knowledge, attitude, and behaviors of health professionals towards smoking cessation in primary healthcare settings. Transl Behav Med 2019; 8:938-943. [PMID: 29444289 DOI: 10.1093/tbm/ibx045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study aimed to assess the behaviors of multiple health professionals in primary healthcare settings in Jordan towards smoking cessation counseling and to determine the barriers to effective smoking cessation behaviors. A survey of 456 health professionals in primary healthcare settings was conducted. A self-administrated questionnaire was used to collect the data. About half of health professionals reported that they usually ask patients about smoking status and advise them to stop smoking (51.4% and 50.5%, respectively). Only 23.7% reported assessing the willingness of the patients to quit smoking and 17.9% reported discussing counseling options with smokers. Considerably fewer percentages of health professionals reported preparing their patients for withdrawal symptoms (6.0%), discussing pharmacotherapies (3.8%), and prescribing nicotine patches (6.4%). Key barriers to smoking cessation counseling, as reported by health professionals, included: insufficient resources and organizational support, limited coverage of cessation interventions, and lack of motivation to quit. Smoking cessation counseling was not routinely implemented by Jordanian health professionals. Barriers to effective delivery of smoking cessation counseling need to be integrated within relevant strategies aiming at enhancing the frequency and quality of health professionals' engagement in smoking cessation.
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Affiliation(s)
- Abdullah Matouq
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET)/Jordan Field Epidemiology Training Program, Jordan Ministry of Health, Amman, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Albaraa Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Anas Al-Rabadi
- Prince Hamzah Hospital/Ministry of Health, Jordan Ministry of Health, Amman, Jordan
| | - Mousa Al Omari
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Ibrahim Iblan
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET)/Jordan Field Epidemiology Training Program, Jordan Ministry of Health, Amman, Jordan
| | - Nihaya Al-Sheyab
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
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Martínez C, Castellano Y, Andrés A, Fu M, Feliu A, Antón L, Ballbè M, Fernández P, Cabrera S, Riccobene A, Gavilan E, Baena A, Margalef M, Tigova O, Quirós N, Guillen O, Company A, Fernández E. Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals. J Nurs Scholarsh 2019; 51:449-458. [PMID: 30874373 DOI: 10.1111/jnu.12469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess changes in the self-reported performance of smoking cessation interventions according to the 5A's model (Ask; Advise; Assess; Assist; and Arrange follow-up) among clinicians; and to identify the main barriers and facilitators in smoking cessation implementation before and after an online smoking cessation training program. DESIGN Pre-post evaluation. METHODS We assessed self-reported smoking cessation interventions in the implementation of the 5A's model among clinicians working in Catalan hospitals (Spain). In addition, we assessed individual-, behavioral-, and organizational-level factors that act as barriers and facilitators in the implementation of the 5A's model. We used a questionnaire of 63 items reflecting each of the 5A's performance (scored from 0 = none to 10 = most possible). The questionnaire was completed both immediately before and 6 months after the training. We analyzed the data of those participants who had a clinical role and answered pre- and post-questionnaires. We used the nonparametric test for paired data (Wilcoxon) to examine changes in scores. FINDINGS A total of 127 clinicians completed the pre-post questionnaire; 63.0% were registered nurses, 17.3% were nursing assistants, 7.9% were physicians, and 11.8% were other professionals (p < .001). Overall, there were significant increases in the implementation of the assist component (from a score of 4.5 to 5.2; p < .003) and arrange a follow-up component (from 3.6 to 4.5; p < .001) of the intervention. Scores in the perception of the level of overall preparation, preparedness in using smoking cessation drugs, level of competence, and organizational recognition improved (p < .001) at the follow-up; however, the score in the perception that implementing smoking cessation is part of their job decreased (from 6.3 to 4.4; p < .001). CONCLUSIONS The online training had a positive impact on the implementation of assist and arrange follow-up components. Although self-preparedness in the management of smokers increased, the motivation and involvement of key professionals decreased. Organizational factors related to the incorporation of resources (such as protocols, records, etc.) should be improved for the correct progression of smoking cessation interventions within the institutions. CLINICAL RELEVANCE Smoking cessation training programs should incorporate some motivational content to increase the engagement of health professionals in smoking cessation interventions in their clinical practice.
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Affiliation(s)
- Cristina Martínez
- Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Department of Public Health, Mental Health and Perinatal Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Statistician, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Granvia de L'Hospitalet; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Ana Andrés
- Lecturer and Researcher, Faculty of Psychology, Education and Sport Sciences, Ramon Llull Universityl, Barcelona, Spain
| | - Marcela Fu
- Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Ariadna Feliu
- Predoctoral student, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Laura Antón
- Program coordinator, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Montse Ballbè
- Program Coordinator and Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, and Cancer Control; and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Paz Fernández
- Coordinator of Nursing Research, Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Sandra Cabrera
- Coordinator of Nursing Researcher, Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Ana Riccobene
- Nurse, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Eva Gavilan
- Nurse and Predoctoral student, Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antoni Baena
- Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Mercè Margalef
- Project Manager, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Olena Tigova
- Project Manager, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO. Av; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Núria Quirós
- Administrative support, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Olga Guillen
- Program Coordinator, E_oncologia Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Assumpta Company
- Director E-oncologia, E_oncologia Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Esteve Fernández
- Director of the Tobacco Control Unit, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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Chavarria J, Liu M, Kast L, Salem E, King AC. A pilot study of Counsel to Quit®: Evaluating an Ask Advise Refer (AAR)-based tobacco cessation training for medical and mental healthcare providers. J Subst Abuse Treat 2019; 99:163-170. [PMID: 30797390 DOI: 10.1016/j.jsat.2019.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Despite tobacco use as the largest preventable cause of premature death in the US, many healthcare providers continue to lack the knowledge and confidence in employing the Ask, Advise, Refer (AAR) model in tobacco cessation treatment delivery. This pilot study evaluated the feasibility and effectiveness of a novel AAR-styled training program, Counsel to Quit®, across a range of healthcare providers and disciplines (i.e., medical, mental health, other). The Counsel to Quit® training program primarily targeted publically-funded settings that serve communities with high smoking rates. METHODS Pre- and post-training surveys were administered to medical, mental health, and other professionals (N = 297) to evaluate the effectiveness of the 60-90 minute Counsel to Quit® counselor training program for improving confidence in the ability to discuss approved tobacco cessation interventions and address the current state of knowledge about the role of electronic cigarettes in tobacco cessation. The trainings were held across 14 different non-profit institutional settings in Chicago, IL. RESULTS The Counsel to Quit® program improved AAR beliefs, the confidence and ability to discuss smoking cessation, and knowledge on the role of electronic cigarettes in tobacco cessation among medical, mental health, and other providers (ps < .001). Interactions showed that Counsel to Quit® improved medical provider confidence in referring patients for smoking cessation the most (p < .001), and also improved mental health providers belief in the importance of tobacco cessation for preventative care the most (ps < .05). CONCLUSIONS Counsel to Quit® is a feasible and effective training for improving AAR beliefs across multiple healthcare provider domains and at different types of publicly-funded healthcare institutions. Further, this training increased provider preparedness to discuss the lack of evidence for e-cigarette use as a form of tobacco cessation.
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Affiliation(s)
- Jesus Chavarria
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S. Maryland Ave (MC-3077), Chicago, IL 60637, USA
| | - Melissa Liu
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S. Maryland Ave (MC-3077), Chicago, IL 60637, USA
| | - Lainie Kast
- Respiratory Health Association, 1440 W. Washington Blvd., Chicago, IL 60607, USA
| | - Erica Salem
- Respiratory Health Association, 1440 W. Washington Blvd., Chicago, IL 60607, USA
| | - Andrea C King
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S. Maryland Ave (MC-3077), Chicago, IL 60637, USA.
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Andrés A, Castellano Y, Fu M, Feliu A, Ballbè M, Antón L, Baena A, Fernández E, Martínez C. Exploring individual and contextual factors contributing to tobacco cessation intervention implementation. Addict Behav 2019; 88:163-168. [PMID: 30205255 DOI: 10.1016/j.addbeh.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous research suggests that smoking cessation interventions are poorly implemented. This study reports the development and testing of a questionnaire including knowledge, attitude, behavioral, and organizational (KABO) factors affecting the implementation of smoking cessation practices in hospitals by health care providers and organizations. METHODS An initial pool of 44 items was developed to assess the individual knowledge, attitudes, and beliefs of health professionals towards smoking cessation practices according to the 5 A's intervention model, as well as organizational barriers and opportunities for its implementation. Items were measured in a scale from 0="Not at all/Never" to 10 = "Completely/Always". Data were collected from health workers (n = 702) in Catalonia. The validity of the instrument was measured by: (a) analyzing the items, (b) assessing the internal structure, (c) estimating the internal consistency, and (d) analyzing the relationship between this tool and the 5 A's intervention model. RESULTS Seven domains were extracted: individual skills, positive organizational support, attitudes and beliefs, individual commitment, organizational resources, beliefs about patient desire/readiness to quit, and organizational endorsement. These domains explained 69.7% of the variance, and allowed for the development of a refined 26-item version of the questionnaire. Both the seven domains and the total scale showed adequate internal consistency. CONCLUSIONS Psychometric testing indicates that the KABO questionnaire is a reliable and valid instrument for assessing the main barriers and facilitators to smoking cessation intervention implementation. Individual factors better explained the implementation of smoking cessation interventions in hospitals, and the seven identified domains can be used for further investigations into how the implementation of evidence-based practices impacts smoking cessation performance.
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Martínez C, Fu M, Castellano Y, Riccobene A, Fernández P, Cabrera S, Gavilan E, Feliu A, Puig-Llobet M, Fuster P, Martínez-Sánchez JM, Montes J, Estrada JM, Moreno C, Falcó-Pegueroles A, Galimany J, Brando C, Suñer-Soler R, Capsada A, Fernández E. Smoking among hospitalized patients: A multi-hospital cross-sectional study of a widely neglected problem. Tob Induc Dis 2018; 16:34. [PMID: 31516433 PMCID: PMC6659490 DOI: 10.18332/tid/92927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A comprehensive smoking ban was recently enacted for acute-care hospital campuses in Spain. The aim of this study was to assess the prevalence and patterns of smoking among inpatients before and during hospitalization. METHODS Multi-center cross-sectional study was conducted in 13 hospitals in the province of Barcelona, Spain from May 2014 to May 2015. Participants were adults who provided informed consent. The sample size was calculated to be representative of each hospital (prevalence 29.4%, precision ± 5%, error 5%). We approached 1228 subjects, 888 accepted to participate and 170 were replaced (were not available or declined to participate). Final sample comprised 1047 subjects. We used a computer-assisted personal interview system to collect data, including sociodemographic variables and use of tobacco before and during hospitalization. Smoking status was validated with exhaled carbon monoxide. We calculated overall tobacco prevalence and investigated associations with participant and center characteristics. We performed multiple polytomous and multilevel logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustments for potential confounders. RESULTS In all, 20.5% (95% CI: 18.1–23.0) of hospitalized patients were smokers. Smoking was most common among men (aOR=7.47; 95% CI: 4.88–11.43), young age groups (18–64 years), and individuals with primary or less than primary education (aOR=2.76; 95% CI: 1.44–5.28). Of the smokers, 97.2% were daily consumers of whom 44.9% had medium nicotine dependence. Of all smokers, three-quarters expressed a wish to quit, and one-quarter admitted to consuming tobacco during hospitalization. CONCLUSIONS Our findings indicate the need to offer smoking cessation interventions among hospitalized patients in all units and service areas, to avoid infringements and increase patient safety, hospital efficiency, and improve clinical outcomes. Hospitalization represents a promising window for initiating smoking interventions addressed to all patients admitted to smoke-free hospitals, specially after applying a smoke-free campus ban.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain.,Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Nursing Science, Gimbernat School, Barcelona, Spain.,Department of Nursing Science, University of Girona, Girona, Spain.,Fundació Althaia, Barcelona, Spain
| | - Anna Riccobene
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain
| | - Paz Fernández
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Sandra Cabrera
- Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Eva Gavilan
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Montse Puig-Llobet
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pilar Fuster
- Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Javier Montes
- Department of Nursing Science, Gimbernat School, Barcelona, Spain
| | - Joan Maria Estrada
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Carmen Moreno
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Jordi Galimany
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Cecilia Brando
- Department of Nursing Science, Gimbernat School, Barcelona, Spain
| | - Rosa Suñer-Soler
- Department of Nursing Science, University of Girona, Girona, Spain
| | | | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
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Jolicoeur D, Cranos CL, Frisard C, Pbert L. Evaluation of a Train-the-Trainer Program to Build Capacity for Training Tobacco Treatment Specialists. Nicotine Tob Res 2018; 21:1480-1487. [DOI: 10.1093/ntr/nty125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/22/2018] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Tobacco-treatment specialists (TTSs) and high-quality TTS training programs are needed to improve access to evidence-based tobacco-dependence treatment. To meet this demand, the University of Massachusetts (UMass) Medical School developed the Train-the-Trainer in Tobacco Treatment (T4) program to build a cadre of trainers to deliver the accredited UMass TTS training programs. This paper reports on the feasibility and quality of TTS trainings led by Certified UMass TTS Trainers (Trainer-led) compared with trainings led by UMass staff (On-site).
Methods
Data were collected between September 2014 and June 2017. Feasibility included the number of Trainers, Trainer-led programs, and participants. Quality compared participant exam results and evaluations of the two training program types.
Results
Fifty-three Trainers were certified during 2014–2017, and conducted 26 TTS trainings with 351 participants. There were no significant differences in participant mean exam scores [On-site = 86.33 (SD = 7.83); Trainer-led = 86.15 (SD = 8.47)], and a similar percentage of participants obtained a passing score on the exam (On-site 94.4%, Trainer-led 94.0%). There were no significant differences in increased self-efficacy in delivering effective tobacco-treatment services [On-site = 2.92, Trainer-led = 2.93; p = .52 (3-point Likert scale, 1 = not at all, 3 = a great deal)] or in overall satisfaction with the training [On-site = 3.84; Trainer-led = 3.81; p = .072 (4-point Likert scale, 1 = very dissatisfied, 4 = very satisfied)].
Conclusions
The Trainer-led model expanded the number of UMass-trained TTSs with equivalent participant knowledge and perceived improvement in ability to deliver effective tobacco-dependence treatment compared with the gold-standard training model. It offers a potentially more accessible option for training TTSs compared with the On-site model.
Implications
Train-the-Trainer in Tobacco Treatment (T4) has increased the capacity to deliver high-quality training to healthcare providers who might not otherwise have access to an accredited TTS training program. Certified Trainers effectively identified potential participants and delivered training that was equivalent in quality to the standard UMass TTS Core Training program. There were no significant differences between the training models in two critical measures: (1) participant exam scores and (2) participants’ rating of improvement in their ability to deliver effective tobacco-dependence treatment. Organizations can now choose from two equally effective models for delivering TTS training based on their unique needs and training populations.
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Affiliation(s)
- Denise Jolicoeur
- Center for Tobacco Treatment Research and Training, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Caroline L Cranos
- Center for Tobacco Treatment Research and Training, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Lori Pbert
- Center for Tobacco Treatment Research and Training, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
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22
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Martínez C, Castellano Y, Company A, Guillen O, Margalef M, Alicia Arrien M, Sánchez C, Cáceres P, Barnoya J, Fernández E. Impact of an online training program in hospital workers’ smoking cessation interventions in Bolivia, Guatemala and Paraguay. GACETA SANITARIA 2018; 32:236-243. [DOI: 10.1016/j.gaceta.2017.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022]
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23
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Martínez C, Castellano Y, Andrés A, Fu M, Antón L, Ballbè M, Fernández P, Cabrera S, Riccobene A, Gavilan E, Feliu A, Baena A, Margalef M, Fernández E. Factors associated with implementation of the 5A's smoking cessation model. Tob Induc Dis 2017; 15:41. [PMID: 29142531 PMCID: PMC5669025 DOI: 10.1186/s12971-017-0146-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/23/2017] [Indexed: 12/04/2022] Open
Abstract
Background Several health organizations have adopted the 5A’s brief intervention model (Ask, Advise, Assess, Assist, Arrange), based on evidence-based guidelines for smoking cessation. We examine individual, cognitive, behavioral, and organizational factors associated with the 5A’s performance among clinical healthcare workers in Catalonia. We also investigate how these factors interact and potentially predict the implementation of each component of the 5A’s. Methods A cross-sectional survey was conducted among clinical health workers enrolled in an online smoking cessation training course (n = 580). The survey included questions about individual characteristics as well as cognitive, behavioral, and organizational factors previously identified in research. We assessed self-reported performance of the 5A’s, assessed on a scale from 0 to 10, and used Multivariate regression to examine factors associated with its performance. Results The performance means (standard deviation) were moderate for the first 3A’s [Ask: 6.4 (3.1); Advise: 7.1 (2.7); Assess: 6.3 (2.8)] and low for the last 2A’s [Assist: 4.4 (2.9); Arrange: 3.2 (3.3)]. We observed a high correlation between Assist and Arrange (r = 0.704, p < 0.001). Having positive experiences and feeling competent were positively associated with performing the 5A’s model and having organizational support with Assist and Arrange. Personal tobacco use among healthcare workers was negatively associated with Advice and Arrange. Conclusions Our study found that clinical healthcare workers do not perform the 5A’s completely. The main barriers identified suggest the need of training and making available practical guidelines in healthcare services. Organizational support is essential for moving towards the implementation of Assist and Arrange. Electronic supplementary material The online version of this article (10.1186/s12971-017-0146-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine and Health Sciences School, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - Y Castellano
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Andrés
- National Institute of Physical Education of Catalonia (INEFC), Av. de l'Estadi, 12-22, 08038 Barcelona, Spain
| | - M Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine and Health Sciences School, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - L Antón
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - P Fernández
- Nursing Research Unit, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Cabrera
- Nursing Research Unit, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Riccobene
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Gavilan
- Medicine and Health Sciences School, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain
| | - A Feliu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Baena
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Margalef
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet, 199-203, E-08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
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Diniz-Freitas M, Insua A, Keat R, Fricain JC, Catros S, Monteiro L, Silva L, Lodi G, Pispero A, Albuquerque R. Web-Based Information on the Treatment of Tobacco Dependence for Oral Health Professionals: Analysis of English-Written Websites. J Med Internet Res 2017; 19:e349. [PMID: 29054831 PMCID: PMC5670309 DOI: 10.2196/jmir.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/09/2017] [Accepted: 09/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have been conducted on the content and quality of Web-based information for patients who are interested in smoking cessation advice and for health care practitioners regarding the content of e-learning programs about tobacco cessation. However, to the best of our knowledge, there is no such information about the quality of Web-based learning resources regarding smoking cessation dedicated to oral health professionals. OBJECTIVE The aim of this study was to identify and evaluate the quality of the content of webpages providing information about smoking cessation for oral health care professionals. METHODS Websites were identified using Google and Health on Net (HON) search engines using the terms: smoking cessation OR quit smoking OR stop smoking OR 3As OR 5As OR tobacco counselling AND dentistry OR dental clinic OR dentist OR dental hygienist OR oral health professionals. The first 100 consecutive results of the 2 search engines were considered for the study. Quality assessment was rated using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) benchmarks, and the HON seal. In addition, smoking cessation content on each site was assessed using an abbreviated version of the Smoke Treatment Scale (STS-C) and the Smoking Treatment Scale-Rating (STS-R). To assess legibility of the selected websites, the Flesch Reading Ease (FRES) and the Flesch-Kinkaid Reading Grade Level (FKRGL) were used. Websites were also classified into multimedia and nonmultimedia and friendly and nonfriendly usability. RESULTS Of the first 200 sites selected (100 of Google and 100 of HON), only 11 met the inclusion criteria and mainly belonged to governmental institutions (n=8), with the others being prepared by Professional Associations (n=2) and nonprofit organizations (n=1). Only 3 were exclusively dedicated to smoking cessation. The average score obtained with the DISCERN was 3.0, and the average score in the FKRGL and FRES was 13.31 (standard deviation, SD 3.34) and 40.73 (SD 15.46), respectively. Of the 11 websites evaluated, none achieved all the four JAMA benchmarks. The mean score of STS-R among all the websites was 2.81 (SD 0.95) out of 5. A significant strong positive correlation was obtained between the DISCERN mean values and the STS-R (R=.89, P=.01). CONCLUSIONS The mean quality of webpages with information for oral health care professionals about smoking cessation is low and displayed a high heterogeneity. These webpages are also difficult to read and often lack multimedia resources, which further limits their usefulness.
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Affiliation(s)
- Márcio Diniz-Freitas
- School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Insua
- School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ross Keat
- Birmingham Dental Hospital, School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | | | - Sylvain Catros
- Department of Dentistry, University of Bordeaux, Bordeaux, France
| | - Luis Monteiro
- Department of Medicine and Oral Surgery, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal.,Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), CESPU, Gandra, Portugal
| | - Luis Silva
- Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), CESPU, Gandra, Portugal
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, University of Milan, Milan, Italy
| | - Alberto Pispero
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, University of Milan, Milan, Italy
| | - Rui Albuquerque
- Birmingham Dental Hospital, School of Dentistry, University of Birmingham, Birmingham, United Kingdom
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Proportion of Time Spent Delivering Support Predicts Stop Smoking Advisor Quit Rate Independently of Training, Experience, and Education. J Smok Cessat 2017. [DOI: 10.1017/jsc.2016.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Despite a downwards trend in smoking prevalence, smoking remains the UK's biggest preventable cause of premature mortality. Specialist stop smoking support programmes provided by the NHS have helped to reduce smoking prevalence and whilst there has been a vast amount of research investigating the most effective behavioural and pharmacological support models, little is known about the impact of smoking cessation advisor's smoking status and clinical effectiveness on quit rates. This study aimed to identify factors that contribute to NHS stop smoking advisor performance using a quantitative cross-sectional design via an online survey that was completed by 159 participants in 24 London boroughs. Multiple regression analyses revealed that level of training, years practiced, level of advisor education, number of patients supported in a given year, and smoking status had no significant impact on NHS stop smoking advisor quit rate in this sample. However, the model revealed that proportion of time spent delivering smoking cessation support was significantly associated with quit rate. It is imperative that this finding is considered when recruiting, commissioning, and training new smoking cessation advisors or provider organisations.
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Kengne Talla P, Gagnon MP, Dawson A. Environmental Factors Influencing Adoption of Canadian Guidelines on Smoking Cessation in Dental Healthcare Settings in Quebec: A Qualitative Study of Dentists' Perspectives. Dent J (Basel) 2016; 4:dj4040040. [PMID: 29563482 PMCID: PMC5806960 DOI: 10.3390/dj4040040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background: This study aimed to understand dentists’ perspective of the environmental determinants which positively or negatively influence the implementation of Canadian smoking cessation clinical practice guidelines (5As: Ask-Advise-Assess-Assist-Arrange) in private dental clinics in Quebec. Methods: This study used a qualitative design and an integrative conceptual framework composed of three theoretical perspectives. Data collection was conducted in individual semi-directed interviews with 20 private dentists lasting between 35 and 45 min. The audio-recorded data were transcribed verbatim, followed by a directed content analysis. Results: Some of the barriers identified to counselling in smoking cessation were lack of time, patient attitude, lack of prescription of nicotine replacement therapies, lack of reimbursement, and the lack of training of the dental team. Enablers cited by participants were the style of dentist’s leadership, the availability of community, human and material resources, the perception of counselling as a professional duty, and the culture of dental medicine. In addition to these variables, dentists’ attitude and behaviour were affected by different organisations giving initial or continual training to dentists, governmental policies, and the compatibility of Canadian smoking cessation guidelines with the practice of dentistry. Conclusion: Our findings will inform the development of smoking cessation interventions in dental healthcare settings.
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Affiliation(s)
- Pascaline Kengne Talla
- Centre de Recherche du CHU de Québec (CRCHUQ)-Hôpital St-François d'Assise, Québec, QC G1L 3L5, Canada.
| | - Marie-Pierre Gagnon
- Centre de Recherche du CHU de Québec (CRCHUQ)-Hôpital St-François d'Assise, Québec, QC G1L 3L5, Canada
- Faculty of Nursing, Laval University, Quebec, QC G1L 3L5, Canada
| | - Aimée Dawson
- Faculty of Dental Medicine, Laval University, Quebec, QC G1L 3L5, Canada.
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Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Becerra-Posada F, Boupha B, Shi G, Turdaliyeva BS. Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico. Reprod Health 2016; 13:70. [PMID: 27283191 PMCID: PMC4901518 DOI: 10.1186/s12978-016-0185-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements. METHODS A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables. RESULTS Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work. CONCLUSIONS This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.
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Affiliation(s)
- Steven J Hoffman
- Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada.
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - G Emmanuel Guindon
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Harkanwal Randhawa
- Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | | | - Boungnong Boupha
- Foreign Affairs Committee and Women's Caucus, Laos National Assembly, Vientiane, Lao PDR
| | - Guang Shi
- Democratic Party of Peasants & Workers in China, Beijing, China
| | - Botagoz S Turdaliyeva
- Department of Health Policy & Management, Kazakh National Medical University, Almaty, Kazakhstan
- Evidence-Based Health Centre, Almaty, Kazakhstan
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Davis JM, Arnett MR, Loewen J, Romito L, Gordon SC. Tobacco dependence education. J Am Dent Assoc 2016; 147:405-12. [DOI: 10.1016/j.adaj.2015.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bascombe TMS, Scott KN, Ballard D, Smith SA, Thompson W, Berg CJ. Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study. HEALTH EDUCATION RESEARCH 2016; 31:375-83. [PMID: 26802106 PMCID: PMC4872592 DOI: 10.1093/her/cyv103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/20/2015] [Indexed: 05/14/2023]
Abstract
Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This qualitative study explored knowledge, beliefs and clinic-based practices regarding traditional and alternative tobacco products (cigar-like products, smokeless tobacco, hookah, e-cigarettes) and marijuana among rural and urban Georgia primary healthcare providers. The sample comprised 20 healthcare providers in primary care settings located in the Atlanta Metropolitan area and rural southern Georgia who participated in semi-structured interviews. Results indicated a lack of knowledge about these products, with some believing that some products were less harmful than traditional cigarettes or that they may be effective in promoting cessation or harm reduction. Few reported explicitly assessing use of these various products in clinic. In addition, healthcare providers reported a need for empirical evidence to inform their clinical practice. Healthcare providers must systematically assess use of the range of tobacco products and marijuana. Evidence-based recommendations or information sources are needed to inform clinical practice and help providers navigate conversations with patients using or inquiring about these products.
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Affiliation(s)
- Ta Misha S Bascombe
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA and
| | | | - Denise Ballard
- Cancer Coalition of South Georgia, Albany, GA 31707, USA
| | - Samantha A Smith
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA and
| | - Winifred Thompson
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA and
| | - Carla J Berg
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA and
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Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Becerra-Posada F, Dejman M, Falahat K, Malek-Afzali H, Ramachandran P, Shi G, Yesudian CAK. Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis. Am J Trop Med Hyg 2016; 94:959-970. [PMID: 26903613 PMCID: PMC4856627 DOI: 10.4269/ajtmh.15-0538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/04/2016] [Indexed: 01/05/2023] Open
Abstract
Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices "often or very often" (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.
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Affiliation(s)
- Steven J. Hoffman
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
| | | | | | | | | | | | | | | | - Parasurama Ramachandran
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
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Choi SH, Kim YH. Factors Affecting Korean Registered Nurses' Intention to Implement Smoking Cessation Intervention. Osong Public Health Res Perspect 2015; 7:63-70. [PMID: 26981345 PMCID: PMC4776271 DOI: 10.1016/j.phrp.2015.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/30/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives Nurses have been identified as an instrumental partner in tobacco reduction. This study aimed to examine factors affecting Korean nurses' intention to implement smoking cessation intervention in Busan, Korea. Methods The participants were a total of 215 Korean registered nurses. A self-administered questionnaire evaluated predisposing factors, motivational factors (attitude, social influence, and self-efficacy) and intention to implement smoking cessation intervention. Data were analyzed by t tests, Pearson's correlation, and hierarchical multiple regression. Results The mean age of the participants was 28.12 ± 5.72 years. The majority of the participants were staff nurses (85.6%), and 64.2% of the sample had < 5 years of work experience. Significant predictors of intention to implement smoking cessation intervention included perceived barrier of smoking cessation intervention (β = −0.128, p = 0.023), willingness to receive smoking cessation training (β = 0.123, p = 0.034), more positive attitude (β = 0.203, p = 0.002), higher social influence (β = 0.292, p < 0.001), and higher self-efficacy toward smoking cessation intervention (β = 0.151, p = 0.021), which explained 45% of the total variance of intention to implement smoking cessation intervention. Conclusion Attitude, social influence, and self-efficacy towards smoking cessation intervention had a significant positive influence in determining the intention to implement smoking cessation intervention. These findings can be used to develop evidence-based smoking cessation training programs for nurses in Korea. The programs should aim for positive attitude, higher social influence, and higher self-efficacy in hospital settings.
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Affiliation(s)
- Sook-Hee Choi
- Department of Nursing, Youngsan University, Yangsansi, Korea
| | - Yun-Hee Kim
- Department of Nursing, Pukyong National University, Busan, Korea
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Guo SE, Wang AL, Shu BC. Self-efficacy in providing smoking-cessation services among psychiatric nurses in central and southern Taiwan: an exploratory study. Int J Ment Health Nurs 2015; 24:158-68. [PMID: 25582504 DOI: 10.1111/inm.12119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Smoking by psychiatric patients remains prevalent. The purpose of this cross-sectional study was to understand the influence of self-efficacy and its correlates among psychiatric nurses when providing smoking-cessation services (SCS). A convenience sample of 193 nurses from psychiatric institutions was obtained. Surveys were conducted using self-report measures regarding SCS provided by psychiatric nurses. The survey questions focused on self-efficacy, attitude, practical experience, and smoke-free policies, and their implementation in the workplace. The participants reported low self-efficacy for providing SCS in their self-assessment, as demonstrated by their scores of 55.3 ± 20.4, on a scale of 0 (low confidence) to 100 (high confidence). Using multiple linear regressions, statistically-significant, relevant factors included perceived provider-related barriers in providing SCS, environmental tobacco smoke exposure, the nurse's attitude towards a patient smoking, and the nurse's frequency and practical experience in providing SCS. The correlates of this self-efficacy can serve as a reference for in-service curriculum planning of SCS by psychiatric nurses. In addition, policies to limit exposure to second-hand tobacco smoke should be explored.
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Affiliation(s)
- Su-Er Guo
- Chronic Diseases and Health Promotion Research Center and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Chiayi, Taiwan
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Increasing the Quality and Availability of Evidence-based Treatment for Tobacco Dependence through Unified Certification of Tobacco Treatment Specialists. J Smok Cessat 2014. [DOI: 10.1017/jsc.2014.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Each year, tobacco use causes over 6 million deaths and is responsible for hundreds of billions of dollars in health care and economic costs in the world (WHO, 2011). If current trends continue, tobacco is expected to kill over 1 billion people in the 21st century, making it one of the single greatest causes of preventable death and disease in history (WHO, 2011). Long-term abstinence from tobacco use dramatically improves individuals’ health, reduces the incidence of tobacco-related disease, and is clearly responsible for saving lives (Anthonisen et al., 2005). Most tobacco users express a desire to achieve long-term abstinence from tobacco use and make numerous unsuccessful quit attempts over the course of many years (Borland, Partos, Yong, Cummings, & Hyland, 2012; CDC, 2011). Evidence-based treatments for tobacco use and dependence greatly improve the chances that quit attempts result in long-term abstinence (Chambless & Hollon, 1998; Chambless et al., 1998; Compas, Haaga, Keefe, Leitenberg, & Williams, 1998; Fiore et al., 2008; Zwar et al., 2004). Increasing the availability of high-quality evidence-based treatment for tobacco use and dependence will make it more likely that tobacco users use evidence-based treatments and that quit attempts translate into long-term abstinence. The professionalisation of treatment for tobacco dependence by the development of a rigorous, unified Tobacco Treatment Specialist (TTS) certification process will increase the availability of high-quality evidence-based treatment for tobacco use and dependence for all tobacco users.
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Nobile CGA, Bianco A, Biafore AD, Manuti B, Pileggi C, Pavia M. Are primary care physicians prepared to assist patients for smoking cessation? Results of a national Italian cross-sectional web survey. Prev Med 2014; 66:107-12. [PMID: 24945695 DOI: 10.1016/j.ypmed.2014.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/03/2014] [Accepted: 06/06/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary purpose of this study is to explore primary care physicians' (PCPs') knowledge, attitudes and self-reported activities provided to patients for smoking cessation. The secondary purpose is to identify the relationships between physician-related characteristics and knowledge, attitudes and self-reported activities for smoking cessation. METHOD A national cross-sectional web survey was conducted in Italy from April through September 2012. RESULTS 722 PCPs completed the questionnaire. The great majority indicated the correct proportion of smokers among patients with lung cancer, the smoking abstention required for risk reduction after smoking cessation, and tobacco as a known major risk factor for chronic obstructive pulmonary disease (COPD), whereas 28.7% knew the Fagerstrom test for the assessment of nicotine dependence. Almost all PCPs reported that they ask all patients if they smoke, inform about the dangers of smoking and recommend to quit smoking, whereas prescription of recommended drugs for smoking cessation varied from 37.7% for nicotine replacement therapy to 4.9% for varenicline. CONCLUSION Despite a positive attitude, Italian PCPs are not prepared to deliver effective interventions for smoking cessation in their patients.
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Affiliation(s)
- Carmelo G A Nobile
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Alessio D Biafore
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Benedetto Manuti
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy.
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Payne TJ, Gaughf NW, Sutton MJ, Sheffer CE, Elci OU, Cropsey KL, Taylor S, Netters T, Whitworth C, Deutsch P, Crews KM. The impact of brief tobacco treatment training on practice behaviours, self-efficacy and attitudes among healthcare providers. Int J Clin Pract 2014; 68:882-9. [PMID: 24589010 DOI: 10.1111/ijcp.12386] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND PURPOSE The need for aggressive efforts to help tobacco users quit remains a healthcare priority. Brief interventions delivered in the healthcare environment continue to be a valuable component of a comprehensive tobacco control policy. Unfortunately, such treatments are offered less often than desired, and quality is variable. Previous research has demonstrated the value of training experiences in increasing treatment availability, quality, as well as improving clinical outcomes. Less is known about how specific clinical activities and other features are impacted as a function of training. These issues were explored within the context of a standardised 5A's (ASK, ADVISE, ASSESS, ASSIST, ARRANGE) brief intervention training program. METHODS A variety of healthcare providers participated in this study. Survey methodology was employed to collect Practice Behaviour, Self-Efficacy and Attitude ratings at pretraining, post training and 6-month follow-up. Linear mixed effects models were used to evaluate primary outcomes, and linear regression to explore the relationships among clinical variables. RESULTS Pretraining data suggested overall modest levels of tobacco treatment activity, with limited direct intervention (ASSIST) or follow-up (ARRANGE) efforts. The training experience was shown to have a substantial and sustained impact on 5A's Practice Behaviour ratings, and other clinical indicators (all Pre vs. Post and Pre vs. Follow-up comparisons p < 0.001). Self-Efficacy at post training predicted practice behaviours at follow-up (for ADVISE, ASSESS, ASSIST and ARRANGE: all p's < 0.05). CONCLUSIONS The value of a structured training experience was confirmed, and findings served to clarify the specific nature of training program impact.
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Affiliation(s)
- T J Payne
- Department of Otolaryngology, University of Mississippi Medical Center, Jackson, MS, USA
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Walters EL, Reibling ET, Wilber ST, Sullivan AF, Gaeta TJ, Camargo CA, Boudreaux ED. Emergency department provider preferences related to clinical practice guidelines for tobacco cessation: a multicenter survey. Acad Emerg Med 2014; 21:785-93. [PMID: 25112653 DOI: 10.1111/acem.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/09/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to assess current emergency department (ED) provider practices and preferences for tobacco cessation interventions. The ED is an opportune place to initiate smoking cessation interventions. However, little is known about ED provider current practices and preferences for cessation counseling in the ED. METHODS This was a survey of ED providers conducted in 2008-2009 (including physicians, nurse practitioners, physician assistants, and nurses), working at least half-time at 10 U.S. academic EDs, regarding adherence to clinical practice guidelines ("5 As") and preferences for cessation interventions/styles. Data analysis occurred in 2012-2013. RESULTS The response rate was 64% (800 out of 1,246 completed surveys). Providers reported strongest adherence to asking about patient smoking status, followed by advising, with significant variance by clinical role. Assessing, assisting, and arranging support for patients was low overall. Most frequently used interventions were to provide patients with a list of telephone numbers for stop-smoking counseling (87%), pamphlets on smoking health risks and the benefits of stopping (85%), and referrals to the National Toll-Free Smoker's Quitline (84%). Most providers (80%) were supportive of personally conducting brief (less than 3 minutes) smoking cessation counseling sessions during the ED visit, emphasizing education and encouragement. The least appealing intervention was writing a prescription for nicotine replacement therapies or medications to stop smoking (35%). CONCLUSIONS Interventions most likely to be used were brief and delivered with a positive tone and included referral to external resources. The logical next step is to design and test interventions that ED providers find acceptable.
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Affiliation(s)
- Elizabeth L. Walters
- The Department of Emergency Medicine; Loma Linda University Medical Center; Loma Linda CA
| | - Ellen T. Reibling
- The Department of Emergency Medicine; Loma Linda University Medical Center; Loma Linda CA
| | - Scott T. Wilber
- The Department of Emergency Medicine; Summa Akron City Hospital; Akron OH
| | - Ashley F. Sullivan
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
| | - Theodore J. Gaeta
- The Department of Emergency Medicine; New York Methodist Hospital; Brooklyn NY
| | - Carlos A. Camargo
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
| | - Edwin D. Boudreaux
- The Department of Emergency Medicine; University of Massachusetts Medical School; Worcester MA
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Champassak SL, Goggin K, Finocchario-Kessler S, Farris M, Ehtesham M, Schoor R, Catley D. A qualitative assessment of provider perspectives on smoking cessation counselling. J Eval Clin Pract 2014; 20:281-7. [PMID: 24628799 PMCID: PMC4441728 DOI: 10.1111/jep.12124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Few studies have examined doctors' views about counselling unmotivated smokers. This study explored doctors' perceptions of useful strategies to motivate patients to quit, how receptive they felt patients were to these strategies, and the benefits and drawbacks of discussing smoking cessation with patients. METHODS Fourteen semi-structured qualitative interviews were conducted with doctors and resident doctors. RESULTS Strategies reported by providers included: educating about the health risks of smoking, using 'scare tactics' to highlight the harmful effects and providing advice about how to quit. Providers believed that most patients were receptive to their strategies, but noted that they lacked feedback to know for sure. Providers saw the possibility of improving patients' health and decreasing overall health care costs as potential benefits, but cited the potential to damage rapport, competing priorities during already rushed visits and uncertainty about the effectiveness of their efforts as drawbacks that reduced their motivation to raise the issue with patients. CONCLUSIONS Doctors believe in the potential benefits of smoking cessation counselling but predominantly report focusing on enhancing patient's risk perceptions. They did not report attempting to use the wider array of recommended and empirically supported methods to counsel their patients. Providing doctors with increased training in motivational counselling and feedback about the efficacy their efforts or supplementing doctor care with behaviour change specialists would likely increase the benefits of counselling to patients.
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Affiliation(s)
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children’s Mercy Hospital and Clinics, University of Kansas Medical Center, USA
| | - Sarah Finocchario-Kessler
- Department of Psychology, University of Missouri - Kansas City, USA
- Department of Family Medicine, University of Kansas Medical Center, USA
| | - Maghen Farris
- Department of Psychology, University of Missouri - Kansas City, USA
| | - Maniza Ehtesham
- School of Medicine, University of Missouri - Kansas City, USA
| | - Rachel Schoor
- Department of Psychology, University of Missouri - Kansas City, USA
| | - Delwyn Catley
- Department of Psychology, University of Missouri - Kansas City, USA
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Celestin MD, Hart A, Moody-Thomas S. Partnering with health care systems to assess tobacco treatment practices and beliefs among clinicians: evaluating the process. Prev Chronic Dis 2014; 11:E91. [PMID: 24874783 PMCID: PMC4042712 DOI: 10.5888/pcd11.130277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Tobacco is a major cause of preventable illness and death. However, clinician use of an evidence-based guideline for treatment of tobacco use is low. This case study describes the process for conducting a pre-intervention assessment of clinician practices and beliefs regarding treatment of tobacco use. Community Context Louisiana State University Health System, one of the largest safety-net public hospital systems in the United States, consists of 10 facilities in population centers across the state of Louisiana. The system serves a large proportion of the state’s underinsured and uninsured, low-income, and racial/ethnic minority populations, groups that have high rates of tobacco use. Methods Activities included 1) partnering with hospital administrators to generate support for conducting a clinician assessment, 2) identifying and adapting a survey tool to assess clinicians’ practices and beliefs regarding treatment of tobacco use, 3) developing a survey protocol and obtaining approval from the institutional review board, and 4) administering the survey electronically, using the hospital’s e-mail system. Outcome Existing partnerships and system resources aided survey administration. Use of the hospital’s internal e-mail system and distribution of an online survey were effective means to engage clinicians. Following notification, 43.6% of 4,508 clinicians opened their e-mail containing the invitation letter with a Web link to the survey; of these, 83.1% (1,634) completed the survey. Interpretation Partnering with stakeholders and using existing resources within the health care system are essential to successful implementation of a system-wide survey of clinician practices and beliefs regarding treatment of tobacco use.
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Affiliation(s)
- Michael D Celestin
- 2020 Gravier St, 3rd Fl, New Orleans, LA 70112. Telephone: 504-568-5742. E-mail:
| | - Alton Hart
- Virginia Department of Health Crater Health District, Petersburg, Virginia
| | - Sarah Moody-Thomas
- Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana
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Tobacco dependence treatment: Influence of training experiences on clinical activities among otolaryngologists. Laryngoscope 2013; 123:3005-9. [DOI: 10.1002/lary.23513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2012] [Indexed: 11/07/2022]
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Kleinfelder J, Price JH, Dake JA, Jordan TR, Price JA. Tobacco training in clinical social work graduate programs. HEALTH & SOCIAL WORK 2013; 38:173-181. [PMID: 24437023 DOI: 10.1093/hsw/hlt008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The leading cause of preventable death, in the most vulnerable segments of society, whom social workers often counsel, is cigarette smoking. The purpose of this study was to assess tobacco smoking cessation training in clinical social work programs. A valid 21-item questionnaire was sent to the entire population of 189 clinical graduate social work programs identified by the Council on Social Work Education. A three-wave mailing process was used to maximize the return rate. Directors from 112 clinical social work programs returned completed questionnaires (61 percent). The majority (91 percent) of directors reported having never thought about offering formal smoking cessation training, and only nine of the programs (8 percent) currently provided formal smoking cessation education. The three leading barriers to offering smoking cessation education were as follows: not a priority (60 percent), not enough time (55 percent), and not required by the accrediting body (41 percent). These findings indicate that clinical social work students are not receiving standardized smoking cessation education to assist in improving the well-being of their clients. The national accrediting body for graduate clinical social work programs should consider implementing guidelines for smoking cessation training in the curriculums.
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Amemori M, Korhonen T, Michie S, Murtomaa H, Kinnunen TH. Implementation of tobacco use cessation counseling among oral health professionals in Finland. J Public Health Dent 2013; 73:230-6. [PMID: 23594270 DOI: 10.1111/jphd.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 03/15/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Clinical guidelines for tobacco use cessation (TUC) counseling recommend that healthcare professionals should provide brief tobacco counseling for all tobacco users. Widespread implementation of these guidelines seems to be insufficient. To enhance adherence to TUC counseling guidelines, it is essential to identify provider behaviors related to a successful implementation. This study aims to assess adherence to TUC counseling guidelines and factors that are associated with counseling behaviors. METHODS A 41-item questionnaire relevant to the implementation of TUC counseling guidelines among healthcare professionals was administered. This questionnaire included items used to evaluate TUC counseling behaviors as well Theoretical Domains Framework (TDF)-based behavior change items. Of the 95 oral health professionals invited from 34 community dental clinics in Finland, 73 professionals (76.8 percent) participated. The TDF factors and their associations to TUC counseling behaviors were analyzed using correlations and logistic regression analyses. RESULTS Adherence to TUC counseling guidelines, especially for providing advice to quit, assisting in quitting and arranging follow-up services, were low. In addition, only 15.1 percent of the providers reported asking about tobacco use and 8.2 percent assessed interest in quitting among the majority (>75 percent) of their patients. Of the behavior change domains, "Memory, Attention and Decision Processes" and "Professional Role and Identity" were found to be significantly associated with TUC counseling behavior among oral health professionals. CONCLUSIONS Regarding the adherence to TUC counseling guidelines, there is room for improvement. The identified TDF factors related to TUC behaviors provide an avenue for targeted interventions to improve guideline implementation.
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Affiliation(s)
- Masamitsu Amemori
- Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland
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Sheffer CE, Anders M, Brackman SL, Steinberg MB, Barone C. Tobacco intervention practices of primary care physicians treating lower socioeconomic status patients. Am J Med Sci 2012; 343:388-96. [PMID: 22008779 PMCID: PMC3263323 DOI: 10.1097/maj.0b013e3182302749] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tobacco use greatly contributes to overall socioeconomic health disparities, and physicians are a major source of information about effective methods for tobacco cessation. This study examined the tobacco intervention practices of primary care physicians in Arkansas who treat a high proportion of lower socioeconomic status patients. More than 70% of respondents' patients were covered by Medicaid and/or Medicare or paid for primary care services without health insurance. Although physicians were highly motivated and considered cessation to be very important, 74% had no training of any kind in the treatment of tobacco dependence and familiarity with the free treatment services in Arkansas was low. Younger and nonwhite physicians and physicians with any type of training in treating tobacco dependence reported more positive attitudes, more frequent intervention behaviors and more familiarity with treatment services. More frequently seeing the effects of tobacco use on the health of patients as well as increased knowledge, preparedness, and perceived effectiveness of treatments were related to a higher frequency of providing cessation assistance. More frequently seeing the effects of tobacco use on patients, as well as increased familiarity with treatment services were related to a higher frequency of referring patients to treatment services. These findings suggest that training experiences that increase physician awareness of the multiplicity of consequences of tobacco use as well as increase knowledge, preparedness, perceived effectiveness of treatments and familiarity with treatment services will increase the frequency with which physicians assist and refer this important patient population.
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Affiliation(s)
- Christine E Sheffer
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, 72205-7199, USA.
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Hoffman SJ, Guindon GE, Lavis JN, Ndossi GD, Osei EJA, Sidibe MF, Boupha B. Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania. Malar J 2011; 10:363. [PMID: 22165841 PMCID: PMC3265439 DOI: 10.1186/1475-2875-10-363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 12/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs). METHODS This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. RESULTS The survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14). CONCLUSIONS Improving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.
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Affiliation(s)
- Steven J Hoffman
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Global Health Diplomacy Program, Munk School of Global Affairs, University of Toronto, Toronto, Ontario, Canada
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA
| | - G Emmanuel Guindon
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- Department of Political Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Eric JA Osei
- Council for Scientific and Industrial Research Secretariat, Accra, Ghana
| | - Mintou Fall Sidibe
- Direction des Études de la Recherche et de la Formation, Comité National d' Éthique, Dakar, Senegal
| | - Boungnong Boupha
- National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
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Leitlein L, Smit ES, de Vries H, Hoving C. Factors influencing Dutch practice nurses’ intention to adopt a new smoking cessation intervention. J Adv Nurs 2011; 68:2185-94. [DOI: 10.1111/j.1365-2648.2011.05903.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Amemori M, Michie S, Korhonen T, Murtomaa H, Kinnunen TH. Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers. Implement Sci 2011; 6:50. [PMID: 21615948 PMCID: PMC3130685 DOI: 10.1186/1748-5908-6-50] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 05/26/2011] [Indexed: 11/17/2022] Open
Abstract
Background Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains. Methods A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature. Results Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, α = 0.86), capability (13.3% of variance, α = 0.83), and opportunity (10.0% of variance, α = 0.71). Conclusions This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.
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Affiliation(s)
- Masamitsu Amemori
- Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland.
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Patel AM, Blanchard SB, Christen AG, Bandy RW, Romito LM. A Survey of United States Periodontists' Knowledge, Attitudes, and Behaviors Related to Tobacco-Cessation Interventions. J Periodontol 2011; 82:367-76. [DOI: 10.1902/jop.2010.100405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Amemori M, Korhonen T, Kinnunen T, Michie S, Murtomaa H. Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial. Implement Sci 2011; 6:13. [PMID: 21320312 PMCID: PMC3055178 DOI: 10.1186/1748-5908-6-13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 02/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers. Trial registration Current Controlled Trials ISRCTN15427433
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Affiliation(s)
- Masamitsu Amemori
- Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland.
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Adoption of policies to treat tobacco dependence in U.S. medical groups. Am J Prev Med 2010; 39:449-56. [PMID: 20965382 DOI: 10.1016/j.amepre.2010.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/04/2010] [Accepted: 07/09/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND There remains an ongoing need to reduce tobacco use in the U.S. Physician organizations, such as medical groups, can support healthcare providers to be more effective in their delivery of tobacco cessation by adopting practices recommended in the Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (PHS Guideline). PURPOSE To document the extent to which activities to reduce tobacco use, as recommended in the PHS Guideline as system-level interventions, are provided within large medical groups in the U.S. METHODS During 2006-2007, data were collected on 339 medical groups operating in the U.S., with 20 or more physicians treating at least one of four chronic conditions. Organizations were surveyed regarding activities to reduce tobacco use as recommended in the PHS Guideline as system-level interventions (i.e., tobacco-use status documentation, policies to promote provider interventions, and staff dedicated to treating tobacco dependence). Between 2008 and 2009, bivariate associations and multivariate logistic regression models assessed the relationship of organizational characteristics and external incentives with adoption of systems strategies for treating tobacco dependence. RESULTS Nearly 83% of medical groups with 20 or more physicians operating in the U.S. in 2006-2007 have adopted one or more strategies recommended as effective to support the treatment of tobacco dependence. However, only 5.6% of medical groups engage in all eight tobacco control activities examined in this study. The two factors that were associated most consistently with medical group policies to treat tobacco dependence were the patient-centeredness of the organization and participation in a quality demonstration program. CONCLUSIONS There is much room for improvement in increasing medical group adoption of systems strategies to reduce tobacco use. The findings in this paper suggest recommendations to achieve these improvements.
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Sheffer CE, Barone C, Anders ME. Training nurses in the treatment of tobacco use and dependence: pre- and post-training results. J Adv Nurs 2010; 67:176-83. [PMID: 21039779 DOI: 10.1111/j.1365-2648.2010.05483.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. BACKGROUND Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. METHOD A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. RESULTS Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. CONCLUSION Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Affiliation(s)
| | - Anne Koerber
- Department of Pediatric Dentistry; University of Illinois at Chicago
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