Background
Dental providers and tobacco use counselling
Improving guideline implementation
Aims and objectives
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develop a TDQ for assessing implementation determinants of TUPAC guidelines among dental providers;
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apply the TDQ to a sample of dental providers to identify implementation difficulties;
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to uncover the possible underlying structure of the theoretical domains.
Methods
Development of the Theoretical Domain Questionnaire
Participants
Statistical analysis
KNOWLEDGE (α = 0.54) | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
I'm unaware of the meanings and objectives of the six A s in the Current Care guidelines on tobacco dependence treatment (Ask, Assess, Account, Advise, Assist, Arrange)* | 7 (9.6) | 12 (16.4) | 25 (34.2) | 15 (20.5) | 14 (19.2) |
I have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation | 26 (35.6) | 27 (37.0) | 12 (16.4) | 7 (9.6) | 1 (1.4) |
I don't know how to promote a tobacco-free lifestyle among youth* | 13 (17.8) | 16 (21.9) | 28 (38.4) | 12 (16.4) | 4 (5.5) |
SKILLS (α = 0.55) |
1
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2
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3
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4
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5
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I know the appropriate questions to ask patients when providing tobacco use cessation counselling | 28 (38.4) | 23 (31.5) | 17 (23.3) | 3 (4.1) | 2 (2.7) |
I know how to prescribe pharmaceutical products for those ready to quit | 34 (46.6) | 20 (27.4) | 9 (12.3) | 8 (11.0) | 2 (2.7) |
I am unsure how to assess patients in their efforts to stop tobacco use* | 2 (2.7) | 8 (11.0) | 23 (31.5) | 18 (24.7) | 22 (30.1) |
Sufficient opportunities are available to learn about promoting a tobacco-free lifestyle | 11 (15.1) | 10 (13.7) | 25 (34.2) | 17 (23.3) | 10 (13.7) |
PROFESSIONAL ROLE AND IDENTITY (α = 0.57) |
1
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2
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3
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4
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5
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Most of my colleagues in this clinic believe that promoting tobacco abstinence is an important part of their professional identity | 7 (9.6) | 22 (30.1) | 27 (37.0) | 9 (12.3) | 8 (11.0) |
Counselling for cessation is not an efficient use of my time* | 15 (20.5) | 9 (12.3) | 26 (35.6) | 15 (20.5) | 8 (11.0) |
BELIEFS ABOUT CAPABILITIES (α = 0.64) |
1
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2
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3
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4
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5
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I am confident in my abilities to prevent patients from using tobacco products | 17 (23.3) | 25 (34.2) | 26 (35.6) | 2 (2.7) | 3 (4.1) |
I am able to make decisions about the risks/benefits of the appropriate use of nicotine replacement therapy | 34 (46.6) | 17 (23.3) | 16 (21.9) | 3 (4.1) | 3 (4.1) |
I have the skills to monitor and assist patients throughout their quit attempt | 35 (47.9) | 21 (28.8) | 11 (15.1) | 4 (5.5) | 2 (2.7) |
BELIEFS ABOUT CONSEQUENCES (α = 0.60) |
1
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2
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3
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4
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5
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My counselling will increase a patient's likelihood of quitting | 7 (9.6) | 18 (24.7) | 24 (32.9) | 21 (28.8) | 3 (4.1) |
Patients appreciate it when I promote tobacco abstinence | 5 (6.8) | 14 (19.2) | 28 (38.4) | 16 (21.9) | 10 (13.7) |
The patients we see in our clinic/department have so many other problems in their lives that stopping tobacco use is a very low priority for them* | 3 (4.1) | 14 (19.2) | 27 (37.0) | 20 (27.4) | 9 (12.3) |
MOTIVATION AND GOALS (α = 0.60) |
1
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2
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3
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4
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5
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I am unwilling to work on improving my provision of tobacco cessation services* | 21 (28.8) | 17 (23.3) | 29 (39.7) | 4 (5.5) | 2 (2.7) |
The importance of patient health helps me to overcome barriers such as lack of time and reimbursement in promoting a tobacco-free lifestyle | 4 (5.5) | 12 (16.4) | 26 (35.6) | 17 (23.3) | 14 (19.2) |
I receive insufficient reimbursement for promoting tobacco abstinence* | 9 (12.3) | 10 (13.7) | 22 (30.1) | 15 (20.5) | 17 (23.3) |
I have insufficient time to promote tobacco abstinence* | 8 (11.0) | 5 (6.8) | 20 (27.4) | 23 (31.5) | 17 (23.3) |
MEMORY, ATTENTION, AND DECISION PROCESS (α = 0.52) |
1
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2
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3
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4
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5
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Deciding whether to promote tobacco abstinence is sometimes difficult* | 20 (27.4) | 13 (17.8) | 17 (23.3) | 15 (20.5) | 8 (11.0) |
Reinforcing tobacco abstinence is easy for me to remember | 8 (11.0) | 14 (19.2) | 23 (31.5) | 19 (26.0) | 9 (12.3) |
ENVIRONMENTAL CONTEXT AND RESOURCES (α = 0.71) |
1
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2
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3
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4
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5
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My dental clinic has no tobacco-related self-help materials/pamphlets to distribute to patients* | 5 (6.8) | 8 (11.0) | 9 (12.3) | 10 (13.7) | 41 (56.2) |
Our dental clinic has a system to provide follow-up support between clinic visits | 60 (82.2) | 4 (5.5) | 0 | 8 (11.0) | 1 (1.4) |
Our dental clinic has a system to cue/prompt providers to counsel against tobacco use | 60 (82.2) | 4 (5.5) | 5 (6.8) | 2 (2.7) | 2 (2.7) |
Our clinic management has taken actions to remove barriers to the provision of tobacco use counselling | 27 (37.0) | 8 (11.0) | 23 (31.5) | 12 (16.4) | 3 (4.1) |
In the dental clinic where I work, I receive no feedback from promoting tobacco abstinence* | 1 (1.4) | 7 (9.6) | 16 (21.9) | 11 (15.1) | 38 (52.1) |
My dental clinic provides insufficient reimbursement for promoting tobacco abstinence* | 1 (1.4) | 7 (9.6) | 20 (27.4) | 14 (19.2) | 31 (42.5) |
SOCIAL INFLUENCES (α = 0.52) |
1
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2
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3
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4
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5
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Our clinic/department generally supports improving the way in which we promote a tobacco-free lifestyle | 16 (21.9) | 10 (13.7) | 28 (38.4) | 13 (17.8) | 6 (8.2) |
Most patients do not want to receive tobacco counselling* | 4 (5.5) | 7 (9.6) | 31 (42.5) | 22 (30.1) | 9 (12.3) |
There is at least one respected individual in our dental clinic who is personally committed to leading our efforts to improve our provision of tobacco cessation services | 44 (60.3) | 10 (13.7) | 11 (15.1) | 4 (5.5) | 4 (5.5) |
My role does not involve assisting patients to stop tobacco use* | 27 (37.0) | 20 (27.4) | 15 (20.5) | 8 (11.0) | 3 (4.1) |
Most patients want to receive tobacco use cessation counselling | 20 (27.4) | 23 (31.5) | 27 (37.0) | 3 (4.1) | 0 |
EMOTION (α = 0.50) |
1
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2
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3
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4
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5
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Helping with tobacco cessation makes me feel useful to patients | 7 (9.6) | 3 (4.1) | 31 (42.5) | 23 (31.5) | 9 (12.3) |
I find counselling patients about tobacco to be frustrating* | 13 (17.8) | 14 (19.2) | 28 (38.4) | 9 (12.3) | 9 (12.3) |
Burn-out prevents me from providing more tobacco use cessation counselling* | 28 (38.4) | 16 (21.9) | 15 (20.5) | 6 (8.2) | 8 (11.0) |
Ethical review and study permissions
Results
Knowledge | Skills | Professional role | Capabilities | Consequences | Motivation | Memory and attention | Environmental resources | Social influences | Emotion | |
---|---|---|---|---|---|---|---|---|---|---|
Knowledge
| 1 | |||||||||
Skills
| 0.60*** | 1 | ||||||||
Professional role
| 0.26* | 0.39** | 1 | |||||||
Capabilities
| 0.50*** | 0.64*** | 0.51*** | 1 | ||||||
Consequences
| 0.18 | 0.36** | 0.53*** | 0.38** | 1 | |||||
Motivation
| 0.31** | 0.39** | 0.62*** | 0.36** | 0.41*** | 1 | ||||
Memory and attention
| 0.50*** | 0.47*** | 0.35** | 0.42*** | 0.31** | 0.44*** | 1 | |||
Environmental resources
| 0.23 | 0.40*** | 0.19 | 0.28* | 0.40** | 0.34** | 0.15 | 1 | ||
Social influences
| 0.19 | 0.44*** | 0.59*** | 0.46*** | 0.71*** | 0.57*** | 0.35** | 0.46*** | 1 | |
Emotion
| 0.20 | 0.41*** | 0.52*** | 0.42*** | 0.46*** | 0.54*** | 0.52*** | 0.22 | 0.52*** | 1 |
DOMAINS | FACTORS | ||
---|---|---|---|
Motivation
|
Capability
|
Opportunity
| |
Knowledge
| 0.033 | 0.88 | 0.083 |
Skills
| 0.24 | 0.77 | 0.35 |
Professional role and identity
| 0.79 | 0.21 | 0.11 |
Beliefs about capabilities
| 0.37 | 0.66 | 0.23 |
Beliefs about consequences
| 0.64 | 0.057 | 0.53 |
Motivation and goals
| 0.73 | 0.25 | 0.16 |
Memory, attention and decision processes
| 0.48 | 0.64 | -0.15 |
Social influences
| 0.71 | 0.11 | 0.54 |
Emotion
| 0.78 | 0.26 | -0.0020 |
Environmental constraints
| 0.086 | 0.21 | 0.87 |
PERCENT OF VARIANCE
| 47.6 | 13.3 | 10.0 |