Acceptability measures for evaluating smoking cessation interventions among individuals with diabetes

Background

The literature indicates that individuals with diabetes do not easily adopt smoking cessation interventions. Given that the success of such interventions depends on patient involvement and attitudes, assessing intervention acceptability, including patient satisfaction and perceived usefulness, is crucial before implementing a smoking cessation intervention. This paper reports the preliminary validation of the satisfaction and perceived usefulness questionnaires for evaluating smoking cessation interventions among individuals with diabetes.

Study design

Validity study.

Methods

The satisfaction questionnaire contained eight statements while the perceived usefulness questionnaire had fourteen; both rated on a 5-point Likert scale. Content validation involved five tobacco cessation facilitators rating item relevance using a 4-point ordinal rating scale, suggesting improvements. The questionnaires were also translated into Maltese for local use and assessed for translation validity using a similar scale. Unanimous agreement among experts was required for item relevance and equivalence. Thirty-four individuals with type 1 or type 2 diabetes, attending a diabetes-specific smoking cessation intervention, received either the Maltese or English versions of the questionnaires. Internal consistency was measured using Cronbach's alpha.

Results

After two rounds of content validation, the experts unanimously agreed on item relevance and conceptual equivalence. Fifteen and sixteen participants completed the Maltese and English versions of the questionnaires, respectively. Both questionnaires' versions were found to have a high internal consistency (>0.8).

Conclusions

These findings provide the initial validation of these instruments for assessing the acceptability of smoking cessation interventions among individuals with diabetes. Further validation in different settings using a larger sample is suggested.

Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model

INTRODUCTION

Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes. Guided by the Information-Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking.

METHODS

A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June 2021, with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals. The interview transcriptions were analyzed using applied thematic analysis.

RESULTS

Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation. Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics. The provision of information on tobacco-associated diabetic complications, by using video messages featuring former smokers' stories was also suggested.

CONCLUSIONS

To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition. Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential. Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit.

Behavioral Therapy for People With Diabetes Who Smoke: A Scoping Review

BACKGROUND

Tobacco smoking exacerbates diabetes-related complications; its prevalence is notwithstanding substantial. Persons with diabetes face a number of barriers and challenges to quitting such as multiple lifestyle restrictions; tailored interventions are required for smoking cessation.

OBJECTIVE

To identify research on behavioral interventions for smoking cessation in diabetes.

METHODS

Studies had to be randomized controlled trials, quasiexperimental or systematic reviews. The behavioral interventions included were: the 5As, Cognitive-Behavioral Therapy, Motivational Interviewing, Contingency Management, Health Coaching and Counselling, as compared to standard care. The outcomes were self-reported and/or biochemically verified smoking cessation. CINAHL Complete, MEDLINE Complete, the Cochrane databases of systematic reviews and randomized controlled trials, PsychInfo and PubMed Central were searched until July, 2023. Keywords used included diabetes, smoking cessation and each of the behavioral interventions included.

RESULTS

1615 papers were identified. Three studies on the 5As/brief advice, 4 on Motivational Intervention and 1 on counseling were retained. The results on the 5As and Motivational Interviewing were conflicting. More intensive interventions appear to be more successful in achieving smoking cessation in smokers with diabetes.

CONCLUSIONS

Future research should focus on the continued development and evaluation of structured smoking cessation interventions based on the 5As, Motivational interviewing and Cognitive Behavioral Therapy.

A telephone-based smoking cessation intervention for individuals with COVID-19: A randomized controlled feasibility study

INTRODUCTION

Increasing evidence suggests that a diagnosis of a respiratory health condition, such as COVID-19, can prompt a smoker to quit, providing an opportunity to promote and support smoking cessation. However, mandatory quarantine, because of a COVID-19 infection, may stimulate an increase in smoking, making such efforts seem inappropriate or ineffective. This study aimed to investigate the feasibility of a telephone-based smoking cessation intervention for smokers with COVID-19 in Malta.

METHODS

An experimental design with a mixed-methods approach was adopted. Participants (n=80) were recruited from a COVID-19 testing center and equally randomized to the intervention (advised to quit and offered three or four telephone-based smoking cessation support sessions) and control (no intervention) groups. Both groups were asked about their smoking habits at baseline and at follow-up at 1 month and at 3 months. The participants in the intervention group were invited to provide feedback on the intervention using questionnaires and by holding interviews.

RESULTS

Participants were recruited at a rate of 74.1% between March and April 2022. Most participants were female (58.8%), with a mean age of 41.6 years who smoked about 13 cigarettes per day. The majority (75%) accepted the offered smoking cessation support, receiving an average of two to three sessions. Findings indicate that the participants were satisfied with the support, finding it useful for attempting to quit. More participants in the intervention group reported a serious quitting attempt and a 7-day point prevalence abstinence at any point during the first month. However, 7-day point prevalence abstinence rates did not differ at the follow-up at 3 months.

CONCLUSIONS

The study suggests that providing smoking cessation support to individuals with COVID-19 is feasible and well-received. However, the findings suggest that the intervention's impact may have been brief. Thus, further research is recommended before conducting a conclusive trial.

Helping smokers with diabetes quit: A scoping review of the interventions utilised, and the challenges and barriers to smoking cessation

Tobacco smoking is recognised as a priority in diabetes management, yet many individuals with diabetes continue to smoke beyond diagnosis. This paper identifies the most promising smoking cessation strategies by reviewing the literature reporting interventions carried out amongst this study population, and the challenges and barriers to smoking cessation. Stand-alone smoking cessation interventions which included pharmacotherapy were found to be more successful in achieving abstinence than interventions which included smoking cessation as part of a broader intervention for improving diabetes management. Misconceptions about smoking and diabetes management were frequently reported, undervaluing smoking cessation. This emphasizes further the need to inform smokers with diabetes about the link between tobacco use and diabetes complications.

The association between platelet reactivity and lipoprotein levels in Framingham Heart Study participants

BACKGROUND

Hypertriglyceridemia is an independent risk factor for major adverse cardiovascular events, though the mechanisms linking triglycerides and platelet function with thrombosis, remain elusive. The aim of this study was to assess the association between platelet function and triglyceride levels.

METHODS

We included participants from the Framingham Heart Study Third Generation cohort, OMNI, and New Offspring Spouse cohort who attended the third examination cycle (2016-2019). Eligible participants were categorized into four triglyceride subgroups.

RESULTS

The study comprised a total of 1897 (55.53 %) participants with normal TG levels; 883 (25.85 %) participants with high-normal TGs; 378 (11.07 %) with borderline high TGs; and 258 (7.55 %) participants with hypertriglyceridemia. After adjusting for age, sex, alcohol consumption, aspirin, statin and P2Y₁₂ inhibitors, the levels of ADP-induced platelet aggregation were inversely associated with total cholesterol levels (P < 0.0001). Platelet disaggregation was associated with low-density lipoprotein and high-density lipoprotein cholesterol levels (P < 0.0001). Lastly, in a shear-stress chamber assay mimicking arterial flow velocities, TG levels in the normal-high group were associated with increased levels of collagen-dependent thrombogenicity (β = 24.16, SE = 6.65, P < 0.0001).

CONCLUSION

Triglyceride levels are associated with altered platelet activation and aggregation. Furthermore, increased platelet-driven thrombogenicity is directly associated with triglyceride levels after adjusting for medications and other covariates.

Effectiveness of intensive stand-alone smoking cessation interventions for individuals with diabetes: A systematic review and intervention component analysis

INTRODUCTION

Tobacco smoking poses a significant threat to the health of individuals living with diabetes. Intensive stand-alone smoking cessation interventions, such as multiple or long (>20 minutes) behavioral support sessions focused solely on smoking cessation, with or without the use of pharmacotherapy, increase abstinence when compared to brief advice or usual care in the general population. However, there is limited evidence so far for recommending the use of such interventions amongst individuals with diabetes. This study aimed to assess the effectiveness of intensive stand-alone smoking cessation interventions for individuals living with diabetes and to identify their critical features.

METHODS

A systematic review design with the addition of a pragmatic intervention component analysis using narrative methods was adopted. The key terms 'diabetes mellitus' and 'smoking cessation' and their synonyms were searched in 15 databases in May 2022. Randomized controlled trials which assessed the effectiveness of intensive stand-alone smoking cessation interventions by comparing them to controls, specifically amongst individuals with diabetes, were included.

RESULTS

A total of 15 articles met the inclusion criteria. Generally, the identified studies reported on the delivery of a multi-component behavioral support smoking cessation intervention for individuals with type I and type II diabetes, providing biochemically verified smoking abstinence rates at follow-up at six months. The overall risk-of-bias of most studies was judged to be of some concern. Despite observing inconsistent findings across the identified studies, interventions consisting of three to four sessions, lasting more than 20 min each, were found to be more likely to be associated with smoking cessation success. The additional use of visual aids depicting diabetes-related complications may also be useful.

CONCLUSIONS

This review provides evidence-based smoking cessation recommendations for use by individuals with diabetes. Nonetheless, given that the findings of some studies were found to be possibly at risk-of-bias, further research to establish the validity of the provided recommendations is suggested.

Heterotopic Mesenteric Ossification With Trilineage Hematopoiesis

Heterotopic ossification (HO) histologically refers to extraskeletal bone formation in non-ossifying tissues, most commonly noted in the extremities, buttocks, abdominal wall, and hip joints. HO developing in the mesentery (heterotopic mesenteric ossification, HMO) is very rare, with fewer than 100 cases reported in the literature. It usually occurs in adult male patients with a history of repeated abdominal trauma. So far, only two cases of HMO have been reported with the development of hematopoietic bone marrow. Here, we report the third case of HMO with true trilineage hematopoiesis in a 66-year-old female with suspicious mesenteric-retained foreign material from prior surgical procedures, including hysterectomy for endometrial adenocarcinoma and multiple repairs for incisional hernia.

Human Intestinal Spirochetosis Incompatible With Dysplastic Adenomatous Epithelium

Human intestinal spirochetosis (HIS) refers to the colonization of spirochetal bacteria in the human intestinal tract. HIS caused by Brachyspira spp. has been recognized for decades, but their pathological and clinical significance is largely unclear. The coincidence of dysplasia in adenoma or adenocarcinoma and HIS is very rare, and whether spirochetes can colonize on dysplastic epithelium remains controversial. Here, we report a case that showed abrupt abolition of mucosal surface fringe formation on a tubular adenoma (TA) and increased cytoplasmic MUC1 expression in the dysplastic epithelial cells compared with adjacent nondysplastic colonocytes. The findings support the hypothesis that the epithelial colonization of spirochetes is significantly reduced by dysplasia likely due to loss of microvilli, and an increase of epithelial MUC1 expression might contribute to reduced spirochetal colonization in colonic mucosa.

Exploring nursing students' need for social presence and its relevance to their learning preferences

Aim

Design

Methods

Results

Impact of a nurse-led brief tobacco cessation training program for healthcare professionals

OBJECTIVE

To assess the impact of a tobacco cessation training program on healthcare professionals' smoking cessation practices, counseling-related opinions, and attitudes about their role in tobacco control.

DESIGN

A single group pre- and post-design.

SAMPLE

Eligible participants (n = 133) were health professionals who attended a training program between September 2018 and June 2019 at specific training sites in Malta.

MEASUREMENTS

An already established questionnaire was used to compare healthcare professionals' practices, opinions, and attitudes before the training program, and at 3-month follow-up.

INTERVENTION

A public health nurse-led, 3-hr training intervention addressing tobacco use and tobacco cessation with emphasis on the 5As (Ask, Advise, Assess, Assist and Arrange) framework.

RESULTS

Healthcare professionals were favorably disposed towards counseling patients to stop. While participants still found it difficult to get clients to quit and lacked the time to counsel patients, they were more likely to deliver tobacco cessation interventions frequently at follow-up.

CONCLUSION

Despite these challenges, this training program was found useful by the participants, who took a more comprehensive approach to address tobacco use. Public health nurses are encouraged to take a leading role in tobacco cessation training initiatives as part of their efforts to improve population health.

Nursing students' evaluation of a gamified public health educational webinar: A comparative pilot study

AIM

To compare undergraduate nursing students' evaluations of a gamified educational webinar to a non-gamified version. Both webinars covered the topic "Determinants of health," part of public health education.

DESIGN

A post-test evaluation design with a comparison group, and an additional qualitative component.

METHODS

First-year students reading for a Bachelor of Science in Nursing at the Malta College of Arts, Science and Technology were randomly allocated into two classes of 26 students each, and to the gamified and non-gamified webinars. The revised "Students Evaluations of Educational Quality" questionnaire was sent to all participants. Participants were also asked to provide comments on their learning experience.

RESULTS

A total of 40 participants who attended the gamified and non-gamified webinars completed the questionnaire. Educational quality was perceived as "good" to "very good," in both groups. Most participants in the gamified webinar group remarked that gamification helped to increase their engagement and interaction.

Critical self-reflection for nurse educators: Now more than ever!

The dynamic healthcare world and increased demands on nurses call for a parallel shift in nursing education that is optimally geared toward effectiveness. Just as student nurses are taught to reflect on their practice to effectively meet clients’ needs, educators also need to be well versed in self-reflection to enhance their teaching methods. Self-reflection is the deliberate consideration of experiences, which when guided by the literature helps an individual gain insight and improve practice. Educators should not only opt for personal reflection but should also seek the views of their students and peers. Self-reflection becomes critical when it goes beyond mere reflection, questioning teaching assumptions, and addressing their social and political context. Given the remarked benefits of using self-reflection in education, and the current COVID-19 global repercussions which have urged faculties to try alternative methods of teaching, a concise guide to self-reflection is hereby provided for use by nurse educators.

Brief tobacco cessation interventions: Practices, opinions, and attitudes of healthcare professionals

INTRODUCTION

Although brief smoking cessation interventions that follow the 5As algorithm (Ask, Advise, Assess, Assist, Arrange) can trigger smokers to quit, routine delivery remains low in Europe. This study aimed to identify the extent of smoking cessation practices of healthcare professionals interested in tobacco cessation, and their opinions and attitudes.

METHODS

A quantitative, cross-sectional survey design was adopted. Healthcare professionals (n=133) who attended one of ten training sessions on brief interventions for smoking cessation, held every month between September 2018 and June 2019 in Malta, were recruited. Univariate logistic regression and non-parametric tests were carried out to identify associations by participants’ characteristics. Potential confounders were ruled out following multivariate analyses.

RESULTS

Most participants were female nurses who had never smoked. While most professionals reportedly asked (76.3%), advised (83.5%) and assessed (70.5%) patients for cessation, fewer provided assistance (40.9%) and arranged followup (24.2%). Compared to other participants, doctors were more likely to have counselled patients over the previous week. Most professionals were favourably disposed towards counselling patients to quit, however, they claimed they had insufficient time to do so. Although most found it difficult to get clients to quit, former smokers were more likely to disagree when compared to those who never smoked (OR=6.86; 95% CI: 2.17–21.71; p=0.001).

CONCLUSIONS

While more initiatives to train healthcare professionals in providing smoking cessation interventions are recommended, lack of sufficient time, being an organisational barrier, requires healthcare management exploration and action. Given that former smokers were more confident in helping patients quit, engaging them in training activities would be of added value.