Transcript Judy Gichuki 873.50KB 2015-11-24 09:03:48

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 costeffective 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
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
5
METHODOLOGY
Study design
Descriptive cross-sectional study
Study area
Public health facilities within Kiambu County
Study population
HCP in public health facilities in Kiambu County
Nursing officers
Medical doctors
Dentists
Clinical officers
Community oral health officers
Data collection
Self administered questionnaires
Sampling
Sample size: 400
6
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
120
Percentage
100
80
60
40
20
0
Never
Past
Current
Female (%)
97.5
1.4
1.1
Male (%)
71.2
18.6
10.2
Smoking status
Smoker identification and intervention
Behavioral cessation intervention
Never
Sometimes
Always
(n = 338)
n (%)
n (%)
n (%)
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 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)
105 (31.0)
178 (52.7)
55 (16.3)
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)
Ask
Advise
Assess
Assess willingness to quit
Assist
Arrange follow up
Set follow up appointment
9
194 (57.4)
103 (30.5)
41 (12.1)
Training on smoking cessation
interventions
Attitude towards provision of smoking
cessation interventions
Attitude level
15%
Positive (6-9)
Negative (0-5)
85%
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
Nicotine gum
41.4
58.6
Nicotine patch
34.6
65.4
Nicotine lozenge
18
82
Bupropion tablets
11.5
88.5
Knowledge of recommended cessation medications
Organizational support in provision of
smoking cessation interventions
Availability of organizational support factors
100
Percentage
80
60
40
20
0
Assessment forms
Brochures
Educational posters Cessation specialists
Available
3.3
5.1
24.9
2.4
Not available
96.7
94.9
75.1
97.6
Organizational support factors
13
Predictive factors for better practice scores
Predictor variable
Classificatio
n
Odds
ratio
Knowledge level
Attitude levels
1.8
1.1
3
0.030
Good
2.9
1.1
8.1
0.033
2.2
1.1
4.7
0.035
2.4
1.1
5.4
0.029
3.6
1.4
7.9
0.004
Negative^
Female^
No^
Yes
Organizational
support
Upper
Average
Male
Training Status
Lower
p
value
Poor^
Positive
Sex
95% C.I. for OR
No^
Yes
14
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.
Recommendations

Fast track implementation of a pre-service and inservice 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
16
ACKNOWLEDGEMENTS




-
KMA
Center for Tobacco control in Africa
International Development Research Centre(IDRC) – Canada
Mentors
Prof Elizabeth Ngugi
Ms Rose Opiyo
THANK YOU !