Open AccessEvaluation of an evidence-based educational intervention aiming to integrate treatment of tobacco dependence into daily clinical practice in primary health care in Crete
Author(s) -
Charis Girvalaki,
Χάρις Γιρβαλάκη
Publication year - 2021
Language(s) - English
Resource type - Dissertations/theses
DOI - 10.12681/eadd/43489
Subject(s) - intervention (counseling) , medicine , psychological intervention , family medicine , tobacco control , population , odds ratio , global positioning system , odds , nursing , physical therapy , environmental health , public health , logistic regression , telecommunications , computer science
Aim: This doctoral dissertation aimed to evaluate the efficacy of a tobacco treatment training intervention among General Practitioners (GPs) working in primary health care in Crete, Greece. The study objectives were: (a) to determine whether the tobacco treatment training intervention when delivered among GPs can increase GPs’ knowledge, attitudes, beliefs, perceived behavioral control, and intentions related to the delivery of tobacco treatment, and (b) whether the tobacco treatment training intervention when delivered among GPs can change GPs’ behaviors related to the delivery of tobacco treatment interventions (4As delivery). Study population & methods: A quasi-experimental pilot study with pre-post evaluation was conducted in Crete, Greece (2015-2016). GPs (n = 24) intervention and control group and a cross-sectional sample of their patients (n = 841) were surveyed before the implementation of the intervention. GPs in the intervention group received training, practice, and patient tools to support the integration of the 4As treatment into clinical routines. Intervention group GPs (n = 14) and a second cross-sectional sample of patients (n = 460) were surveyed 4 months following the intervention to assess changes in outcomes of interest. Multilevel modeling was used to analyze data.Results: Among GPs exposed to the intervention, significant increases in 6 of the 13 domains of knowledge, self-efficacy (14.3% vs. 64.3%; p=0.034) and rates of 4As delivery were documented between the pre-and post-assessment and compared to the control group. Specifically, the adjusted odds ratios (AOR) and 95% confidence intervals (CI) for 4As delivery between the intervention and control groups were: AOR ‘ask’ 3.66 (95%CI 2.61, 5.14; p<0.001); AOR ‘advice’ 4.44 (95%CI 3.18, 6.21; p<0.001); AOR ‘assist’ 13.71 (95%CI 9.30, 20.19; p<0.001) and AOR ‘arrange’ 4.75 (95%CI 2.67, 8.45; p<0.001).Conclusions: This is the first study to evaluate a multi-component tobacco treatment intervention in primary health care in Crete, Greece. The study findings demonstrate that the tobacco treatment training intervention in primary care settings was associated with significant improvements in the rates at which GPs deliver evidence-based tobacco treatment into their daily clinical practice. Future research should examine methods for supporting broader dissemination of well-designed training interventions in general practice in Greece and other European countries.