Improving tobacco cessation interventions in hospitals: Pre-post evaluation of an innovative health systems intervention in Catalonia (Spain).

This study measured changes in healthcare professionals' (HCPs) performance in tobacco cessation intervention before and 6 months after a health system intervention. The intervention involved exposure to online training for staff and the implementation of a structured organizational change-level practice model that included some strategies, comprising establishing tobacco cessation steering groups with champions in each hospital, developing tailored protocols and guidelines within each organization, conducting on-site workshops for clinicians, and creating posters and pocket materials summarizing the intervention. Pre-post evaluation in four hospitals in Barcelona province (Catalonia, Spain). We assessed the knowledge, attitudes, behaviors, and organizational factors (KABO) and the performance of each of the components of the 5As Model for Treating Tobacco Use according to a scale from 0 ("Never") to 10 ("Always") among HCPs. We performed Wilcoxon signed-rank tests for paired samples and assessed changes in performance by performing linear regression. A total of 255 HCPs completed the pre-post evaluation. All components of the 5As Model increased, with "Assist" and "Arrange a follow-up" showing the greatest improvement. Several KABO dimensions significantly increased, including individual skills (mean score: 3.3-5.7, P < .001), attitudes and beliefs (4.8-5.4, P < .001), individual commitment (5.9-6.6, P < .001), and perception of having positive organizational support (4.3-4.7, P < .001). An increase in each point in individual skills and support of the organization was associated with increased rates of 5As delivery, with the greatest associations found for "Assist" (0.60 and 0.17, respectively) and "Arrange a follow-up" (0.71 and 0.18, respectively). The intervention was successful in increasing HCPs individual skills, attitudes and beliefs, individual commitment, and perception of having positive organizational support and the performance of all components of the 5As. Future research should focus on strategies that promote organizational support, a dimension that is essential to increasing Assist and Arrange, which were less implemented at baseline.

This study aimed to assess the impact of a health system intervention on healthcare professionals' (HCPs) ability to help patients quit tobacco use. The intervention involved exposure to online training for staff and the implementation of a structured organizational change-level practice model that included some strategies, comprising establishing tobacco cessation steering groups with champions in each hospital, developing tailored protocols and guidelines within each organization, conducting on-site workshops for clinicians, and creating posters and pocket materials summarizing the intervention. The study took place in four hospitals in Barcelona province. We measured changes in HCPs' knowledge, attitudes, behaviors, and organizational factors related to tobacco cessation interventions. We also evaluated the performance of different components of the 5As Model, which guides tobacco cessation interventions (Ask, Advise, Assess, Assist, and Arrange a follow-up). The results showed significant improvements in all components of the 5As Model, with "Assist" and "Arrange a follow-up" showing the most substantial enhancement. Several key dimensions, including individual skills, attitudes, commitment, and perception of organizational support, also improved significantly. Furthermore, we found that increased individual skills and organizational support were associated with higher rates of delivering the 5As components, particularly "Assist" and "Arrange a follow-up." In conclusion, the health system intervention successfully enhanced HCPs' skills, attitudes, commitment, and perception of organizational support, leading to improved performance in helping patients quit tobacco use. Future research should explore strategies to further promote organizational support, especially for components like "Assist" and "Arrange a follow-up" that were less commonly implemented initially.

Factors associated with changes in inpatients' smoking pattern during hospitalization and one month after discharge: A cohort study.

INTRODUCTION: Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. OBJECTIVES: The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. METHODS: A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25-item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi-square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. RESULTS: Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical-surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). CONCLUSIONS: Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence-based tobacco cessation programs at the organizational-level, including post-discharge active quitting smoking support. CLINICAL RELEVANCE: Three-quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.

Gaining insight into the implementation of an e-learning smoking cessation course in Latin American countries.

Continuous medical education focused on health problems emerging in low- and middle-income countries (LMICs) is scarce. Although tobacco consumption is increasing in LMICs, there is a lack of tobacco cessation training programs in these countries. To promote smoking cessation interventions in Bolivia, Guatemala and Paraguay, we adapted an e-learning program developed in Catalonia (Spain). This process evaluation study reports on reach, dose and satisfaction of participants with the course, as well as the contextual factors of its application. We conducted a multiple method evaluation, which included a survey and several focus groups, each one specific to the same type of healthcare professional (nurses, doctors, other professionals). Two hundred and ninety-two participants registered into the online course. The motivation for undertaking the course was different between doctors and nurses. The main sources of difficulty in enrolling and finishing the course were the technical problems experienced when accessing the platform, and lack of acquaintance with computers and the Internet in general. Our results show that implementing e-learning education in hospitals from LMICs is feasible, especially when there are similarities between participating countries and the country in which the original program was developed. However, several elements such as strong organizational commitment, technical support and resources and adequate communication channels should be provided to facilitate enrollment and training completion. Efforts to improve Internet access should be made to avoid jeopardizing students' motivation to enroll and complete online training.

Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals.

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.

Impact of an online training program in hospital workers' smoking cessation interventions in Bolivia, Guatemala and Paraguay / Impacto de un programa formativo online en cesación tabáquica dirigido a trabajadores hospitalarios de Bolivia, Guatemala y Paraguay

Objective: To examine changes in hospital workers' interventions before and after online training. Method: Pre-post evaluation of the self-reported performance of the 5A's by hospital workers from the three organizations involved. We assessed individual, behavioural, and organisational-level factors through a questionnaire that included 43 items (0 = none to 10 = most possible) completed before and 6 months after the training. Medians and interquartile ranges were calculated. To examine changes, the non-parametric test for paired data (Wilcoxon) was used. Results: 202 professionals (76 in Bolivia, 79 in Guatemala, and 47 in Paraguay) finished the course, of these 99 (28, 42, and 29 respectively) completed both questionnaires before and after the training. Overall, there was an increase in the performance of each of the 5A components [Ask (7 to 9): Advise (7 to 9); Assess (6 to 8); Assist (2 to 7); and Arrange a follow up (0.52 to 5); all p <0.001]. Doctors, former smokers, and those from Paraguay obtained higher scores. The level of perception of the participants degree of preparedness, level of competence and familiarity with resources increased (p <0.001). Conclusion: The online training had a positive impact on the implementation of the brief intervention. Online education on smoking cessation is feasible and effective in improving smoking cessation interventions in these countries

Objetivo: Examinar los cambios en las intervenciones de los trabajadores antes y después de la formación. Método: Evaluación pre-post de la intervención breve autorreportada para dejar de fumar (5A). Se evaluaron factores individuales, de comportamiento y de nivel organizativo mediante un cuestionario de 43 ítems (de 0 = nada a 10 = completamente). Los cuestionarios se completaron antes y 6 meses después de la formación. Se calcularon medianas y rangos intercuartílicos. Para examinar los cambios se utilizó la prueba no paramétrica para datos apareados (Wilcoxon). Resultados: 202 profesionales (76 en Bolivia, 79 en Guatemala y 47 en Paraguay) finalizaron el curso; de ellos, 99 (28, 42 y 29, respectivamente) completaron ambos cuestionarios. Hubo un aumento en el desempeño de cada uno de los componentes de las 5A [Averiguar (7,5 a 9); Asesorar (7 a 9); Analizar (6 a 8); Ayudar (2 a 7); y Acordar un seguimiento (0,5 a 5); p <0,001]. Los médicos, los exfumadores y los profesionales de Paraguay obtuvieron puntuaciones más altas. El grado de preparación, el nivel de competencia y la familiaridad con los recursos aumentó entre los participantes (p <0,001). Conclusión: El curso tuvo un impacto positivo en la implementación de la intervención breve. La formación online en cesación tabáquica es factible y eficaz en estos países

Impact of an online training program in hospital workers' smoking cessation interventions in Bolivia, Guatemala and Paraguay.

OBJECTIVE: To examine changes in hospital workers' interventions before and after online training. METHOD: Pre-post evaluation of the self-reported performance of the 5A's by hospital workers from the three organizations involved. We assessed individual, behavioural, and organisational-level factors through a questionnaire that included 43 items (0 = none to 10 = most possible) completed before and 6 months after the training. Medians and interquartile ranges were calculated. To examine changes, the non-parametric test for paired data (Wilcoxon) was used. RESULTS: 202 professionals (76 in Bolivia, 79 in Guatemala, and 47 in Paraguay) finished the course, of these 99 (28, 42, and 29 respectively) completed both questionnaires before and after the training. Overall, there was an increase in the performance of each of the 5A components [Ask (7 to 9): Advise (7 to 9); Assess (6 to 8); Assist (2 to 7); and Arrange a follow up (0.52 to 5); all p <0.001]. Doctors, former smokers, and those from Paraguay obtained higher scores. The level of perception of the participants degree of preparedness, level of competence and familiarity with resources increased (p <0.001). CONCLUSION: The online training had a positive impact on the implementation of the brief intervention. Online education on smoking cessation is feasible and effective in improving smoking cessation interventions in these countries.

Adaptation, Implementation Plan, and Evaluation of an Online Tobacco Cessation Training Program for Health Care Professionals in Three Spanish-Speaking Latin American Countries: Protocol of the Fruitful Study.

BACKGROUND: Tobacco cessation training programs to treat tobacco dependence have measureable effects on patients' smoking. Tobacco consumption in low- and middle-income countries (LMICs) is high and slowly decreasing, but these countries usually lack measures to face the epidemic, including tobacco cessation training programs for health professionals and organizations. Based on a previous online smoking cessation training program for hospital workers in Spain, the Fruitful Study aims to increase smoking cessation knowledge, attitudes, self-confidence, and performance interventions among health care professionals of three Spanish-speaking low- and middle-income Latin American and Caribbean (LAC) countries. OBJECTIVE: The purpose of this paper is to describe the methodology and evaluation strategy of the Fruitful Study intended to adapt, implement, and test the effectiveness of an online, evidence-based tobacco cessation training program addressed to health professionals from Bolivia, Guatemala, and Paraguay. METHODS: This study will use a mixed-methods design with a pre-post evaluation (quantitative approach) and in-depth interviews and focus groups (qualitative approach). The main outcomes will be (1) participants' attitudes, knowledge, and behaviors before and after the training; and (2) the level of implementation of tobacco control policies within the hospitals before and after the training. RESULTS: To date, adaptation of the materials, study enrollment, and training activities have been completed. During the adaptation, the main mismatches were language background and content adaptation. Several aids were developed to enable students' training enrollment, including access to computers, support from technicians, and reminders to correctly complete the course. Follow-up data collection is in progress. We have enrolled 281 hospital workers. Results are expected at the beginning of 2017 and will be reported in two follow-up papers: one about the formative evaluation and the other about the summative evaluation. CONCLUSIONS: There is a need to learn more about the cultural and content elements that should be modified when an online tobacco cessation training program is adapted to new contexts. Special attention should be given to the personal and material resources that could make the implementation possible. Results from the Fruitful Study may offer a new approach to adapting programs to LMICs in order to offer education solutions with the use of emerging and growing communication technologies. CLINICALTRIAL: Clinicaltrials.gov NCT02718872; https://clinicaltrials.gov/ct2/show/NCT02718872 (Archived by WebCite at http://www.webcitation.org/6mjihsgE2).

Training in the prevention of cervical cancer: advantages of e-learning.

Cervical cancer remains the second most common cancer for women worldwide and is the cancer priority in most low- and middle-income countries (LMIC). The development of vaccines against the human papilloma virus (HPV) and the impact of technology both for the detection of HPV and cervical cancer represent milestones and new opportunities in prevention. New internet-based technologies are generating mass access to training programmes. This article presents the methodology for developing an online training programme for the prevention of cervical cancer as well as the results obtained during the four year period wherein the same programme was delivered in Latin America.