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

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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

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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 !