Empowering volunteers to perform smoking- cessation service with a workshop training program using participatory action research Presenter: I-chuan Li Professor National Yang-Ming University Presenter: I-chuan Li Professor National Yang-Ming University

The High Prevalence Smoking Rate There is a noticeably high prevalence rate in industrialized nations for smoking. In Taiwan still 35% of the men and 4.1% of the women of 15 years and older were smokers (DOH 2012). 2

3 The Adverse Effects of Smoking Tobacco consumption causes a wide range of diseases, including multiple types of cancer, chronic obstructive pulmonary disease, cardiovascular disease, pregnancy complications, cataracts and osteoporosis. In 2011 approximately 18,000 Taiwanese dies of smoking-related disease (Taiwan DOH 2012).

Background of this Study The Department of Health has initiated a program to recruit and train volunteers to assist public health nurses in health centers with smoking-cessation services. However, no previous study has evaluated the effects of this program and there is a lack of information that is related to appropriate training content for the volunteers.

The Rational of Training Volunteers The reason for choosing lay persons as health volunteers from different communities in the city was they are seen as less threatening to many smokers who may be wary of seeking professional help and can be seen as an alternative to communication with health professionals as the ‘experts’. 5

However, the limitation to use those pay people in communities as smoking volunteers is they have no enough health knowledge regarding to hazards of smoking, ways to quit smoking effectively. Thus, they feel less confidence with performing services of providing smoking cessation to smokers in the community. 6

Aim of the Project The objective of this study was to assist community volunteers in raising smoking cessation participation, thereby increasing their interest and capabilities in helping services of smoking cessation. 7

We examine the effects of a two-days training workshop that used an empowerment concept to promote these volunteers competence to enhance their abilities to assist with smoking- cessation programs. 8

Study Design Participatory action research was used for this study with qualitative and quantitative data collected using a mixed method to identify the effects of competency. 9

The Content of Training Workshop The training sessions, designed by this research team, were combined lecture presentation, motivational dialogue, group discussion, and role playing.

The first phase of training workshop Topics of dialogue for four focus groups were: what your own personality traits are helpful for you to be a smoking volunteer, what your strength to be a smoking volunteer, and ways to improve your confidence of being a smoking volunteer. 11

The second phase of the training workshop The lecture was to provide smoking cessation knowledge by health professionals including smoking hazards, quitting methods, triggers of smoking, and how to incorporate the smoking cessation strategies into their daily life. 12

The third phase of the training Role play was utilized to incorporate what they have learned from the lectures, conditions to trig the smoking in their daily life and how to refuse the smoke, and strategies to persuade people not smoking or quit smoking. 13

The forth phase of the training The sharing and evaluation activities were to collect their thoughts and changes during this training period. The qualitative data for the process evaluation has been collected. 14

Participants A total of 70 volunteers were recruited from 29 counties within New Taipei City. The response rate was 86%. At the end of the workshop on, 60 health volunteers were present for 100% of the total classes held and were willing to complete the pre and post-assessment test. 15

Instrument Self-efficacy Empowerment” Scale was developed originally by Rogers et al. (1997) and subsequently modified by Wu (2004) to measure perception of self-efficacy by health volunteers in communities. 16

Self-efficacy Empowerment” Scale The scale consists of 35 items with 4-point Likert-type criteria (ranging from strongly disagree to strongly agree). Total scores ranges from 35 to 140. Five domains include in the original scale were : self-efficacy/self-esteem, power/powerlessness, community activism, righteous anger, and optimism-control over the future. The domain of “ righteous anger” was deleted in this study because of the cultural insensitivity. 17

Results: Participants Characteristics Age ranged from 24 years to 76 years; The majorities (77.3%) of them were female; 100% are married; high school graduates made up 40.9%. 72.4% of participants had the experiences in other kinds of volunteering services in communities such as health screening, school children activities, and recreational activities. More than 70% of participants have not received any training program for the past year. 18

Results- Self-efficacy Empowerment The results showed that this program has increased volunteer competency significantly (paired t = 18.79, p = 0.000). 19

Results-Four Domains of Self- efficacy Empowerment Their confidence in self-esteem, community activism, power/powerlessness, and optimism-control over the future were significantly improved (paired t = 9.69, p = 0.002; paired t = 14.04, p <.000; paired t = 15.46, p <.000; and paired t = 12.59, p <.000, respectively). 20

21 Results of focus groups with participants Qualitative accomplishments perceived by participants were: ‘the interest of participating in training courses has been enhanced ’, ‘the importance of participating in training has been raised ’, ‘the confidence of performing the roles of smoking volunteers has been increased ’, and ‘the volunteer can be involved in the decision-making processes of smoking cessation with the public health nurses’.

Discussion Subjects rated this training program as highly recommended because they had been actively involved in the training process according to their needs by perceiving that they had devoted to their obligations as well as enhanced their capabilities. 22

Health volunteers, particularly positive role models for promoting smoking cessation services to smokers in communities, can be difficult to recruit because most often they have to face their families, relatives, neighbors, and friends. 23

Subjects re-defined their roles as smoking volunteers and confident to educate their family members, neighbor, and friends to quit smoking as seen from the results of quantitative and process evaluation. 24

Study limitations The generalizability of the results is limited. There was no comparison group which could make it more difficult to determine if effects of this study were initiated by the workshop. 25

Conclusion The effect of the training program on competency has been shown. This training content has been suggested to the health centers as part of the regular training program for smoking-cessation volunteers. 26

Implication for practice Public health nurses have responsibilities to provide training workshop for health volunteers by using the empowerment concept in order to increase their confidence. Nurses, particularly public health nurses have a responsibility to work with health volunteers as a partner to provide empowering training workshops for them. 27

The mixed method of qualitative and quantitative data analysis is needed to identify effects of training for health volunteers, especially for smoking volunteers. 28

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