Background
Methods
Participants
Survey
Ethical considerations
Data analysis
Results
Participant characteristics
Overall | Clinical Health care workers | Non-clinical Health care workers |
p
| ||||
---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||
Overall | 699 | 100 | 580 | 82.1 | 119 | 17.9 | <0.001 |
Sexa
| |||||||
Men | 135 | 19.3 | 107 | 18.4 | 28 | 23.5 | 0.162 |
Women | 559 | 80.0 | 471 | 81.2 | 88 | 73.9 | |
Agea
| |||||||
< 40 years/old | 342 | 48.9 | 291 | 50.2 | 51 | 42.9 | 0.199 |
≥ 40 years/old | 305 | 43.6 | 248 | 42.8 | 57 | 47.9 | |
Professional group | |||||||
Doctor | 52 | 7.4 | 43 | 7.4 | 9 | 7.6 | <0.001 |
Registered nurses | 375 | 53.6 | 345 | 59.5 | 30 | 25.2 | |
Nursing Assistants | 143 | 20.5 | 131 | 22.6 | 12 | 10.1 | |
Others | 129 | 18.5 | 61 | 10.5 | 68 | 57.1 | |
Working experiencea
| |||||||
< 14 years | 326 | 46.6 | 271 | 46.7 | 55 | 46.2 | 0.756 |
≥ 14 years | 326 | 46.6 | 268 | 46.2 | 58 | 48.7 | |
Smoking | |||||||
Smokers | 170 | 24.3 | 137 | 23.6 | 33 | 27.7 | 0.603 |
Former smokers | 213 | 30.5 | 177 | 30.5 | 36 | 30.3 | |
Never smokers | 316 | 45.2 | 266 | 45,9 | 50 | 42.0 | |
Health care organization | |||||||
Hospital | 592 | 84.7 | 488 | 84.1 | 104 | 87.4 | 0.369 |
Other health care organizations | 107 | 15.3 | 92 | 15.9 | 15 | 12.6 | |
Previous Training | |||||||
No | 565 | 80.8 | 469 | 80.9 | 96 | 80.7 | 0.962 |
Yes | 134 | 19.2 | 111 | 19.1 | 23 | 19.3 |
Overall | Doctors | Registered nurses | Nursing Assistants | Others |
p
| ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | ||
Overall | 580 | 100 | 43 | 7.4 | 345 | 59.5 | 131 | 22.6 | 61 | 10.5 | <0.001 |
Sex | |||||||||||
Men | 107 | 18.5 | 23 | 54.8 | 43 | 12.5 | 20 | 15.3 | 21 | 34.4 | <0.001 |
Women | 471 | 81.5 | 19 | 45.2 | 301 | 87.5 | 111 | 84.7 | 40 | 65.6 | |
Agea
| |||||||||||
< 40 years/old | 291 | 54.0 | 23 | 54.8 | 199 | 62.2 | 38 | 32.2 | 31 | 52.5 | <0.001 |
≥ 40 years/old | 248 | 46.0 | 19 | 45.2 | 121 | 37.8 | 80 | 67.8 | 28 | 47.5 | |
Working experience | |||||||||||
< 14 years | 271 | 50.3 | 24 | 55.8 | 168 | 51.7 | 52 | 44.8 | 27 | 49.1 | 0.533 |
≥ 14 years | 268 | 49.7 | 19 | 44.2 | 157 | 48.3 | 64 | 55.2 | 28 | 50.9 | |
Smoking | |||||||||||
Smokers | 137 | 23.6 | 5 | 11.6 | 72 | 20.9 | 40 | 30.5 | 20 | 32.8 | <0.001 |
Former smokers | 177 | 30.5 | 15 | 34.9 | 90 | 26.1 | 51 | 39.9 | 21 | 34.4 | |
Never smokers | 266 | 45.9 | 23 | 53.5 | 183 | 53.0 | 40 | 30.5 | 20 | 32.8 | |
Health care organization | |||||||||||
Hospital | 488 | 84.1 | 34 | 79.1 | 299 | 86.7 | 113 | 86.3 | 42 | 68.9 | 0.004 |
Other health care organizations | 92 | 15.9 | 9 | 20.9 | 46 | 13.3 | 18 | 13.7 | 19 | 31.1 | |
Previous Training | |||||||||||
No | 111 | 19.1 | 6 | 14.0 | 85 | 24.6 | 13 | 9.9 | 7 | 11.5 | 0.001 |
Yes | 469 | 80.9 | 37 | 86.0 | 260 | 75.4 | 118 | 90.1 | 54 | 88.5 |
Self-reported performance and knowledge of tobacco cessation resources
Ask | Advise | Assess | Assist | Arrange | ||||||
---|---|---|---|---|---|---|---|---|---|---|
mean (sd) |
p
| mean (sd) |
p
| mean (sd) |
p
| mean (sd) |
p
| mean (sd) |
p
| |
Overall | 6.4 (3.1) | 7.1 (2.7) | 6.3 (2.8) | 4.4 (2.9) | 3.2 (3.3) | |||||
Individual characteristics | ||||||||||
Profession | ||||||||||
Doctors | 8.5 (2.4) | <.001 | 8.1 (2.7) | 0.001 | 7.0 (2.5) | 0.018 | 4.4 (2.9) | 0.069 | 3.8 (3.2) | 0.027 |
Nurses | 7.0 (2.9) | 7.2 (2.5) | 6.5 (2.6) | 4.6 (3.0) | 3.4 (3.4) | |||||
Others | 4.9 (3.2) | 6.7 (3.0) | 5.8 (3.1) | 4.0 (2.9) | 2.7 (3.0) | |||||
Sex | ||||||||||
Women | 6.3 (3.1) | 0.102 | 7.0 (2.7) | 0.304 | 6.3 (2.8) | 0.715 | 4.4 (2.9) | 0.450 | 3.1 (3.3) | 0.477 |
Men | 6.8 (3.2) | 7.2 (2.9) | 6.2 (2.8) | 4.6 (3.0) | 3.4 (3.2) | |||||
Smoking | ||||||||||
Smokers | 5.8 (3.3) | 0.006 | 6.1 (2.9) | <.001 | 5.9 (2.9) | 0.046 | 3.9 (2.7) | 0.018 | 2.5 (2.8) | 0.014 |
Former smokers | 6.4 (3.1) | 7.5 (2.6) | 6.5 (2.7) | 4.7 (3.0) | 3.3 (3.4) | |||||
Never smokers | 6.7 (3.0) | 7.3 (2.6) | 6.4 (2.7) | 4.5 (3.0) | 3.5 (3.3) | |||||
Age | ||||||||||
< 40 years/old | 6.5 (3.0) | 0.568 | 6.8 (2.7) | 0.001 | 6.1 (2.8) | 0.049 | 4.3 (2.8) | 0.378 | 2.9 (3.0) | 0.226 |
≥ 40 years/old | 6.3 (3.3) | 7.4 (2.8) | 6.5 (2.8) | 4.5 (3.1) | 3.4 (3.5) | |||||
Working experience | ||||||||||
< 14 years | 6.3 (3.0) | 0.094 | 6.8 (2.7) | 0.001 | 6.2 (2.7) | 0.126 | 4.3 (2.8) | 0.387 | 3.1 (3.1) | 0.476 |
≥ 14 years | 6.6 (3.2) | 7.4 (2.7) | 6.5 (2.7) | 4.5 (3.0) | 3.3 (3.4) | |||||
Previous Training | ||||||||||
Yes | 7.2 (2.5) | 0.023 | 7.8 (2.2) | 0.003 | 7.1 (2.4) | 0.002 | 5.8 (2.8) | <.001 | 4.9 (3.3) | <.001 |
No | 6.2 (3.3) | 6.9 (2.8) | 6.1 (2.8) | 4.1 (2.9) | 2.8 (3.1) | |||||
Organizational characteristics | ||||||||||
Type of center | ||||||||||
Hospital | 6.3 (3.1) | 0.158 | 7.1 (2.8) | 0.961 | 6.3 (2.8) | 0.125 | 4.4 (3.0) | 0.291 | 3.1 (3.2) | 0.021 |
Others | 6.8 (3.2) | 7.1 (2.7) | 6.7 (2.8) | 4.7 (2.8) | 3.9 (3.3) | |||||
Type of organization | ||||||||||
Public | 6.6 (3.1) | 0.014 | 7.1 (2.7) | 0.942 | 6.3 (2.7) | 0.588 | 4.4 (2.9) | 0.702 | 3.1 (3.2) | 0.540 |
Private | 5.8 (3.3) | 7.0 (3.0) | 6.4 (3.0) | 4.5 (3.0) | 3.4 (3.3) |
Correlations of the performance of the 5A’s smoking cessation components
Barriers and opportunities for performance of the 5A’s model
Ask | Advise | Assess | Assist | Arrange | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Overall | Acceptable (≥ 5) | Low (< 5) | Acceptable (≥ 5) | Low (< 5) | Acceptable (≥ 5) | Low (< 5) | Acceptable (≥ 5) | Low (< 5) | Acceptable (≥ 5) | Low (< 5) | ||||||
mean (SD) | mean (SD) | mean (SD) |
p
| mean (SD) | mean (SD) |
p
| mean (SD) | mean (SD) |
p
| mean (SD) | mean (SD) |
p
| mean (SD) | mean (SD) |
p
| |
Cognitive Factors | ||||||||||||||||
Motivation to help patients to quit | 8.1 (1.9) | 8.4 (1.6) | 7.4 (2.5) | <.001 | 8.4 (1.6) | 6.8 (2.5) | <.001 | 8.4 (1.6) | 7.3 (2.5) | <.001 | 8.5 (1.5) | 7.8 (2.1) | <.001 | 8.6 (1.4) | 7.9 (2.0) | <.001 |
Importance of cessation in their job | 8.2 (1.1) | 8.5 (1.8) | 7.4 (2.4) | <.001 | 8.5 (1.7) | 6.9 (2.5) | <.001 | 8.5 (1.7) | 7.2 (2.5) | <.001 | 8.6 (1.6) | 7.8 (2.2) | <.001 | 8.7 (1.4) | 8.0 (2.2) | 0.001 |
Self-reported preparedness | 4.4 (2.6) | 4.8 (2.5) | 3.2 (2.5) | <.001 | 4.7 (2.5) | 2.1 (2.2) | <.001 | 4.7 (2.5) | 3.2 (2.4) | <.001 | 5.6 (2.2) | 3.2 (2.3) | <.001 | 5.9 (2.1) | 3.6 (2.4) | <.001 |
Preparedness in using drugs | 3.4 (2.7) | 3.8 (2.8) | 2.1 (2.2) | <.001 | 3.7 (2.8) | 2.0 (2.1) | <.001 | 3.8 (2.7) | 2.2 (2.3) | <.001 | 4.6 (2.6) | 2.2 (2.3) | <.001 | 5.2 (2.5) | 2.5 (2.3) | <.001 |
Competency in assisting smokers | 5.0 (2.6) | 5.5 (2.4) | 3.2 (2.3) | <.001 | 5.4 (2.5) | 3.0 (2.3) | <.001 | 5.4 (2.4) | 3.2 (2.5) | <.001 | 6.1 (2.2) | 3.7 (2.4) | <.001 | 6.5 (2.0) | 4.2 (2.5) | <.001 |
Security to motivate smokers | 6.3 (2.1) | 6.7 (1.9) | 5.0 (2.2) | <.001 | 6.7 (1.8) | 4.5 (2.3) | <.001 | 6.7 (1.8) | 4.9 (2.5) | <.001 | 7.1 (1.5) | 5.5 (2.3) | <.001 | 7.2 (1.4) | 5.8 (2.2) | <.001 |
Wish more training | 8.3 (2.1) | 8.5 (1.8) | 7.6 (2.5) | <.001 | 8.6 (1.8) | 7.1 (2.7) | <.001 | 8.6 (1.7) | 7.3 (2.8) | <.001 | 8.6 (1.7) | 8.0 (2.3) | 0.003 | 8.6 (1.6) | 8.1 (2.3) | 0.043 |
It is part of my job | 6.4 (3.3) | 7.1 (2.9) | 4.1 (3.3) | <.001 | 6.8 (3.1) | 4.6 (3.5) | <.001 | 6.9 (2.1) | 4.5 (3.6) | <.001 | 7.4 (2.7) | 5.3 (3.5) | <.001 | 7.6 (2.6) | 5.7 (3.4) | <.001 |
Behavioral Factors | ||||||||||||||||
Uses additional resources to intervene | 5.8 (2.5) | 6.3 (2.2) | 4.4 (2.9) | <.001 | 6.2 (2.3) | 3.9 (3.0) | <.001 | 6.2 (2.2) | 4.3 (3.1) | <.001 | 6.7 (2.0) | 4.9 (2.8) | <.001 | 6.6 (1.9) | 5.4 (2.8) | <.001 |
Frequency in seeing tobacco-related diseases | 7.8 (2.1) | 8.1 (1.8) | 6.8 (2.5) | <.001 | 8.1 (1.8) | 6.4 (2.6) | <.001 | 8.0 (1.8) | 6.9 (2.6) | <.001 | 8.1 (1.7) | 7.4 (2.4) | 0.001 | 8.2 (1.5) | 7.5 (2.3) | 0.006 |
Familiar with practical guidelines for smoking cessation | 2.4 (2.7) | 2.9 (2.8) | 0.8 (1.4) | <.001 | 2.7 (2.8) | 0.7 (1.2) | <.001 | 2.8 (2.8) | 0.8 (1.5) | <.001 | 3.6 (2.8) | 1.1 (1.7) | <.001 | 4.6 (2.7) | 1.2 (1.8) | <.001 |
Previous positive experiences | 3.7 (3.2) | 4.3 (3.1) | 1.8 (2.4) | <.001 | 4.1 (3.1) | 1.5 (2.3) | <.001 | 4.3 (3.1) | 1.6 (2.2) | <.001 | 5.2 (2.1) | 1.1 (2.4) | <.001 | 5.8 (2.8) | 2.5 (2.7) | <.001 |
Organizational and Support Factors | ||||||||||||||||
It is protocolized in my organization | 4.5 (3.4) | 4.9 (3.3) | 2.9 (3.0) | <.001 | 4.8 (3.4) | 2.8 (2.1) | <.001 | 4.9 (3.3) | 3.0 (3.2) | <.001 | 5.6 (3.2) | 3.2 (3.1) | <.001 | 6.0 (2.1) | 3.6 (3.3) | <.001 |
Required by supervisors | 3.1 (3.3) | 4.5 (3.4) | 2.4 (2.6) | <.001 | 4.3 (3.4) | 2.3 (2.6) | <.001 | 4.4 (3.3) | 2.5 (2.1) | <.001 | 5.2 (3.3) | 2.7 (2.9) | <.001 | 5.6 (3.1) | 3.1 (3.1) | <.001 |
Organizational support | 4.7 (3.2) | 5.2 (3.2) | 3.0 (2.8) | <.001 | 5.0 (3.2) | 2.1 (2.9) | <.001 | 5.1 (3.2) | 3.1 (3.0) | <.001 | 5.1 (2.1) | 3.3 (2.9) | <.001 | 6.6 (2.8) | 3.7 (3.0) | <.001 |
Factors associated with performance of each component of the 5A’s smoking cessation intervention model
Dependent variable | Ask adjusted
| Advise adjusted
| Assess adjusted
| Assist adjusted
| Arrange adjusted
| ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Independent variable | Estimate | 95% CI |
p
| Estimate | 95% CI |
p
| Estimate | 95% CI | p | Estimate | 95% CI |
p
| Estimate | 95% CI |
p
|
Individual | |||||||||||||||
Smoking status (smoke) | −0.232 | (−0.790; 0.327) | 0.415 | −0.630 | (−1.099–0.162) | 0.008 | −0.027 | (−0.543; 0.489) | 0.918 | −0.234 | (−0.670; 0.202) | 0.292 | −0.771 | (−1.306;-0.235) | 0.005 |
Smoking status (former smoke) | −0.031 | (−0.545; 0.484) | 0.906 | 0.069 | (−0.357; 0.496) | 0.749 | −0.019 | (−0.495; 0.456) | 0.936 | 0.190 | (−0.207; 0.586) | 0.348 | −0.110 | (−0.604; 0.384) | 0.662 |
Sex (male) | 0.197 | (−0.369; 0.763) | 0.495 | 0.049 | (−0.426; 0.524) | 0.841 | −0.009 | (−0.529; 0.512) | 0.974 | 0.058 | (−0.383; 0.499) | 0.795 | 0.143 | (−0.409; 0.695) | 0.611 |
Previous education (yes) | −0.482 | (−1.064; 0.099) | 0.104 | 0.182 | (−0.289; 0.654) | 0.448 | −0.259 | (−0.787; 0.269) | 0.336 | −0.482 | (−0.945;-0.019) | 0.041 | −0.074 | (−0.626; 0.478) | 0.792 |
Profession (doctor) | 2.155 | (1.253; 3.056) | 0.000 | 0.304 | (−0.447; 1.056) | 0.427 | 0.138 | (−0.702; 0.979) | 0.747 | −0.819 | (−1.523;-0.115) | 0.023 | −0.181 | (−1.042; 0.680) | 0.679 |
Profession (nurse) | 0.640 | (0.100; 1.180) | 0.020 | −0.420 | (−0.831;-0.009) | 0.045 | −0.353 | (−0.848; 0.142) | 0.162 | −0.232 | (−0.617; 0.152) | 0.236 | −0.184 | (−0.658; 0.291) | 0.448 |
Cognitive | |||||||||||||||
Motivation to help patients to quit | – | 0.177 | (0.048; 0.306) | 0.007 | – | – | – | ||||||||
Importance of cessation in their job | – | 0.130 | (0.012; 0.249) | 0.031 | 0.151 | (0.029; 0.274) | 0.015 | – | – | ||||||
Self-reported preparedness | – | – | – | 0.183 | (0.093; 0.273) | <0.001 | – | ||||||||
Preparedness in using drugs | – | – | – | – | 0.107 | (0.001; 0.213) | 0.048 | ||||||||
Competency in assisting smokers | 0.157 | (0.050; 0.264) | 0.004 | – | 0.126 | (0.027; 0.224) | 0.012 | 0.201 | (0.117; 0.285) | <0.001 | 0.184 | (0.082; 0.286) | <0.001 | ||
Security to motivate smokers | 0.151 | (0.019; 0.283) | 0.025 | 0.183 | (0.076; 0.291) | 0.001 | 0.151 | (0.029; 0.273) | 0.016 | – | – | ||||
Wish more training | – | 0.226 | (0.125; 0.327) | <0.001 | 0.130 | (0.019; 0.241) | 0.022 | – | – | ||||||
It is part of my job | 0.236 | (0.150; 0.323) | <0.001 | – | 0.111 | (0.032; 0.189) | 0.006 | – | – | ||||||
Behavioral factors | |||||||||||||||
Uses additional resources to intervene | 0.139 | (0.043; 0.236) | 0.005 | 0.146 | (0.067; 0.226) | <0.001 | 0.191 | (0.104; 0.278) | <0.001 | 0.202 | (0.132; 0.272) | <0.001 | – | ||
Frequency in seeing tobacco-related diseases | 0.221 | (0.103; 0.340) | <0.001 | 0.277 | (0.177; 0.376) | <0.001 | – | – | – | ||||||
Familiar with practical guidelines for smoking cessation | – | – | – | 0.188 | (0.106; 0.269) | <0.001 | 0.423 | (0.317; 0.529) | <0.001 | ||||||
Previous positive experiences | 0.099 | (0.013; 0.185) | 0.024 | 0.130 | (0.067; 0.193) | <0.001 | 0.164 | (0.086; 0.242) | <0.001 | 0.242 | (0.172; 0.312) | <0.001 | 0.198 | (0.114; 0.282) | <0.001 |
Organizational and Support Factors | |||||||||||||||
It is protocolized in my organization | – | – | 0.091 | (0.024; 0.158) | 0.008 | 0.070 | (0.003; 0.136) | 0.042 | – | ||||||
Required by supervisors | 0.080 | (0.003; 0.158) | 0.043 | – | – | – | – | ||||||||
Organizational support | – | – | – | 0.085 | (0.013; 0.158) | 0.021 | 0.161 | (0.086; 0.236) | <0.001 | ||||||
R2
| 0.425 | 0.459 | 0.394 | 0.582 | 0.523 |