factors associated with health care providers’ practice of smoking cessation interventions in...
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Factors associated with health care providers’ practice of smoking
cessation interventions in public health facilities in Kiambu County,
Kenya
Dr Judy Gichuki
43rd KMA annual scientific conference
OUTLINE
Background Objectives Methodology Results Discussion & conclusion Recommendations
BACKGROUND
2.5 million adults use tobacco in Kenya (Global adults tobacco survey, 2014)
19.1% of men and 4.5% of women currently use tobacco
77.4% of current smokers planned to or were thinking about quitting
Of smokers who visited a healthcare provider in the past 12 months, only 3 in 10 were advised to quit smoking (MOH, 2014)
BACKGROUND cont.
HCP have a key role to play in tobacco control by encouraging and motivating patients to quit smoking
Research has shown that smoking cessation interventions by HCP are both efficacious and cost-effective with regard to patient quitting outcomes
5A’s smoking cessation model Ask about smoking & record the smoking status of each
patient Advise smokers to quit Assess the smoker’s willingness to quit. Assist smokers in their attempt to quit smoking Arrange follow up of the patient
5
OBJECTIVES
To establish HCPs’ level of practice of various smoking cessation interventions
To determine factors associated with health care providers’ practice of smoking cessation interventions
6
METHODOLOGY
Study designDescriptive cross-sectional studyStudy areaPublic health facilities within Kiambu CountyStudy populationHCP in public health facilities in Kiambu County
Nursing officers Medical doctorsDentistsClinical officersCommunity oral health officers
Data collectionSelf administered questionnairesSamplingSample size: 400
RESULTS Socio-demographic characteristics 338 respondents Sex: 59 (17.5%) males ; 279 (82.5%) females, Age: mean = 35; SD: 9 Practice years: mean= 11 years; SD: 9 Cadre:
Nurses:251 (74.3%) Medical officers: 17 (5%) Clinical officers: 61 (18%) Dentists: 2 (0.6%) Community oral health officers: 7 (2.1%)
HCP SMOKING STATUS
Fig. 2: Smoking status of participants
0
20
40
60
80
100
120
Smoking status
Per
cent
age
Female (%) 97.5 1.4 1.1
Male (%) 71.2 18.6 10.2
Never Past Current
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Smoker identification and intervention
Behavioral cessation intervention Never Sometimes Always
(n = 338) n (%)
n (%) n (%)
Ask
Ask smoking status 12 (3.6) 208 (61.5) 118 (34.9)
Ask number of cigarettes smoked 59 (17.5) 181 (53.5) 98 (29.0)
Advise
Advise smoking patients to quit 10 (3.0) 181 (53.5) 147 (43.5)
Discuss smoking risks and cessation benefits 16 (4.7) 223 (66.0) 99 (29.3)
Assess
Assess willingness to quit 105 (31.0) 178 (52.7) 55 (16.3)
Assist
Discuss about previous quit attempts 102 (30.2) 192 (56.8) 44 (13.0)
Discuss use of NRT 218 (64.5) 98 (29.0) 22 (6.5)
Assist patients set up a quit date 181 (53.6) 122 (36.0) 35 (10.4)
Arrange follow up
Set follow up appointment 194 (57.4) 103 (30.5) 41 (12.1)
Training on smoking cessation interventions
Attitude towards provision of smoking cessation interventions
Attitude level
85%
15%
Positive (6-9)
Negative (0-5)
Knowledge on smoking cessation interventions Poor knowledge score (0-9): 139 (41%) Average knowledge score (10-14): 171(51%) Good knowledge score (15-20 ): 28 (8%)
KNOWLEDGE ITEM
Correct Incorrect /
% Don’t know
%
Knowledge on nicotine dependence and withdrawal symptoms
Patients who smoke within 30minutes of waking up are likely to be less dependent on nicotine as compared to those who smoke much later in the day
51.2 48.8
Knowledge of recommended cessation medications
Nicotine gum 41.4 58.6
Nicotine patch 34.6 65.4
Nicotine lozenge 18 82
Bupropion tablets 11.5 88.5
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Organizational support in provision of
smoking cessation interventions
Availability of organizational support factors
0
20
40
60
80
100
Organizational support factors
Pe
rce
nta
ge
Available 3.3 5.1 24.9 2.4
Not available 96.7 94.9 75.1 97.6
Assessment forms Brochures Educational posters Cessation specialists
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Predictive factors for better practice scores
Predictor variable Classification
Odds 95% C.I. for OR
ratio Lower Upperp
value
Knowledge level Poor^
Average 1.8 1.1 3 0.030
Good 2.9 1.1 8.1 0.033
Attitude levels Negative^
Positive 2.2 1.1 4.7 0.035
Sex Female^
Male 2.4 1.1 5.4 0.029
Training Status No^
Yes 3.6 1.4 7.9 0.004
Organizational support
No^
Yes 2.1 1.1 3.9 0.021
DISCUSSION & CONCLUSION
Most health care workers did not routinely provide smoking cessation care to patients
Findings were comparable to similar studies in Africa. In a study among HCP in Egypt, only 36% of the HCP stated that they always advised their patients to quit smoking (Eldein, et al 2013)
There was inadequate organizational support to facilitate increased involvement of healthcare workers in providing smoking cessation care to patients
Smokers who turn to the health system may not be offered smoking cessation interventions because health care workers have inadequate knowledge, techniques and organizational support to deal with a smoker who wants to quit.
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Recommendations Fast track implementation of a pre-service and in-
service standard curriculum for training HCP’s on smoking cessation ( role of e- Learning)
Dissemination of guidelines for screening, documentation and treatment of tobacco dependence by the Ministry of health and County governments
MOH & County government should provide support to HCP in provision of smoking cessation interventions e.g. IEC materials, referral mechanisms for intensive support, system prompts for smoker identification and cessation medications
ACKNOWLEDGEMENTS
KMA Center for Tobacco control in Africa International Development Research Centre-
(IDRC) – Canada Mentors- Prof Elizabeth Ngugi- Ms Rose Opiyo
THANK YOU !
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