Tailored Internet Program to Improve OB Providers' Smoking Cessation Counseling

定制互联网计划以改善产科服务提供商的戒烟咨询

• 批准号: 8589514
• 负责人: David Farrell
• 金额: $ 27.08万
• 依托单位: PEOPLE DESIGNS, INC.
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-05 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8589514
• 关键词: Address; Age; American; Caring; Charge; Clinical Skills; Clip; Communication; Competence; Counseling; Discipline of obstetrics; Educational Intervention; Educational process of instructing; Elements; Emotions; Feedback; Funding; Guidelines; Gynecology; Health; Home environment; Hour; Individual; Internet; Intervention; Lead; Learning; Left; Medical Technology; Methods; Modeling; Motivation; Oncologist; Online Systems; Patients; Perception; Perinatal; Persons; Phase; Population; Pregnancy; Pregnant Women; Preventive; Primary Care Physician; Primary Health Care; Process; Program Acceptability; Provider; Public Health; Resources; Risk; Services; Small Business Innovation Research Grant; Smoke; Smoking; Source; Teaching Method; Technology; Testing; Time; Training; Training Programs; Treatment Efficacy; Visit; Weight; Woman; Work; Writing; base; college; continuing medical education; cost; cost effective; efficacy testing; evidence base; fetal tobacco exposure; improved; infant morbidity/mortality; innovation; lectures; maternal cigarette smoking; pregnant; prenatal smoking; programs; psychosocial; public health relevance; reproductive; satisfaction; skills; skills training; smoking cessation; theories; therapy design; usability

DESCRIPTION (provided by applicant): Smoking among pregnant women poses risks to the baby; yet, up to one-third of women continue to smoke during pregnancy. Obstetric providers are charged to help women quit. Most providers, however, have not learned the most effective counseling methods. Programs to teach OB providers must be easy for busy providers to use and effective without much of a time commitment from providers. In this application, we propose to develop medical technology to improve smoking cessation counseling skills among obstetric care providers. Fortunately, effective, evidence-based provider counseling strategies, such as the 5 A's-Ask, Advise, Assess, Assist and Arrange exist. Yet, ineffective methods of teaching the 5 A's exist, namely through written guidelines or didactic presentations. Even though providers might have received these other educational resources, most obstetric care providers only Ask and Advise, two of the least critical elements of the 5 A's. When taught with effective methods, providers can learn specific communication skills50-59 that subsequently lead to improved health outcomes.50, 59, 60 The proposed intervention uses an internet-based, interactive training program that incorporates examples of providers' own smoking cessation counseling communication from actual audio-recorded obstetric visits. The design of this intervention addresses several factors that are keys for a successful training intervention with practicing OB providers.62, 63 First, practicing clinicians need programs they can incorporate into their busy schedules.64-66 This training should be brief, easy to access, and not interfere with their practice. Second, the intervention needs to be theory-based and consistent with educational principles. Interactive continuing medical education is rated as the one of the best methods for teaching new skills and clinical practices69, 79, 80 and has been shown to increase learner retention and satisfaction.81 Finally, the training needs to be relevant to the provider.62 63, 65, 67 Personally relevant information is more attended to, processed more carefully, and retained longer. Providers also need feedback on the communication and cannot learn just from being told which skills to use. Providers tend to inaccurately assess their level of competence with skills, and only with feedback, are they able to improve. We have already collected audio recordings of actual encounters from obstetric providers. We also have created two similar interventions, one for primary care physicians addressing weight and the other for oncologists addressing negative emotion. Thus, we are building on our current work. To develop this intervention, we will use our audio-recorded first obstetric visits between obstetrics providers and their pregnant patients who smoke. We will adapt our primary care intervention that addressed weight to address prenatal smoking. We will then pilot test this intervention among obstetric provides and assess usability, acceptability, satisfaction, and potential impact. Once successful with our Phase I aims, we will apply for Phase II funding to test the efficacy of this intervention.

描述（由申请人提供）：孕妇吸烟对婴儿构成风险；然而，多达三分之一的女性在怀孕期间继续吸烟。产科服务提供者有责任帮助妇女戒烟。然而，大多数提供者还没有学会最有效的咨询方法。教授 OB 提供者的计划必须易于繁忙的提供者使用且有效，而无需提供者投入太多时间。在此应用中，我们建议开发医疗技术来提高产科护理人员的戒烟咨询技能。幸运的是，有效的、基于证据的提供者咨询策略是存在的，例如 5 A 询问、建议、评估、协助和安排。然而，存在无效的 5A 教学方法，即通过书面指南或教学演示。尽管提供者可能已经获得了这些其他教育资源，但大多数产科护理提供者仅提出询问和建议，这是 5A 中最不重要的两个要素。当采用有效的方法进行教学时，提供者可以学习特定的沟通技巧50-59，从而改善健康结果。50,59,60拟议的干预措施使用基于互联网的交互式培训计划，其中结合了提供者自己的戒烟咨询沟通的例子来自实际的产科就诊录音。该干预措施的设计解决了几个因素，这些因素是对执业产科提供者进行成功培训干预的关键。62, 63 首先，执业临床医生需要可以纳入其繁忙日程的计划。64-66 该培训应该简短、易于访问，并且不干扰他们的练习。其次，干预需要以理论为基础，符合教育原则。交互式继续医学教育被评为教授新技能和临床实践的最佳方法之一69,79,80，并已被证明可以提高学习者的保留率和满意度。81最后，培训需要与提供者相关。62 63 , 65, 67 个人相关信息得到更多关注、更仔细处理并保留更长时间。提供者还需要有关沟通的反馈，并且不能仅通过被告知要使用哪些技能来学习。提供者往往不准确地评估他们的技能能力水平，只有通过反馈，他们才能提高。我们已经从产科提供者处收集了实际遭遇的录音。我们还制定了两种类似的干预措施，一种是为初级保健医生解决体重问题，另一种是为肿瘤学家解决负面情绪问题。因此，我们正在以当前的工作为基础。为了开发这种干预措施，我们将使用产科提供者和吸烟孕妇之间的首次产科就诊录音。我们将调整针对体重的初级保健干预措施来解决产前吸烟问题。然后，我们将在产科服务中试点测试这种干预措施，并评估可用性、可接受性、满意度和潜在影响。一旦成功实现第一阶段的目标，我们将申请第二阶段的资金来测试这一干预措施的有效性。