Factors associated with health care providers’ practice of smoking cessation interventions in public health facilities in Kiambu County, Kenya Dr Judy Gichuki 43 rd KMA annual scientific conference

OUTLINE Background Objectives Methodology Results Discussion & conclusion Recommendations

BACKGROUND 2.5 million adults use tobacco in Kenya (Global adults tobacco survey, 2014) 19.1% of men and 4.5% of women currently use tobacco 77.4% of current smokers planned to or were thinking about quitting Of smokers who visited a healthcare provider in the past 12 months, only 3 in 10 were advised to quit smoking (MOH, 2014)

BACKGROUND cont. HCP have a key role to play in tobacco control by encouraging and motivating patients to quit smoking Research has shown that smoking cessation interventions by HCP are both efficacious and cost- effective with regard to patient quitting outcomes 5A’s smoking cessation model Ask about smoking & record the smoking status of each patient Advise smokers to quit Assess the smoker’s willingness to quit. Assist smokers in their attempt to quit smoking Arrange follow up of the patient

5 OBJECTIVES To establish HCPs’ level of practice of various smoking cessation interventions To determine factors associated with health care providers’ practice of smoking cessation interventions

6 METHODOLOGY Study design Descriptive cross-sectional study Study area Public health facilities within Kiambu County Study population HCP in public health facilities in Kiambu County Nursing officers Medical doctors Dentists Clinical officers Community oral health officers Data collection Self administered questionnaires Sampling Sample size: 400

RESULTS Socio-demographic characteristics 338 respondents Sex: 59 (17.5%) males ; 279 (82.5%) females, Age: mean = 35; SD: 9 Practice years: mean= 11 years; SD: 9 Cadre: Nurses:251 (74.3%) Medical officers: 17 (5%) Clinical officers: 61 (18%) Dentists: 2 (0.6%) Community oral health officers: 7 (2.1%)

HCP SMOKING STATUS

9 Smoker identification and intervention Behavioral cessation intervention NeverSometimesAlways (n = 338) n (%) Ask Ask smoking status12 (3.6)208 (61.5)118 (34.9) Ask number of cigarettes smoked59 (17.5)181 (53.5) 98 (29.0) Advise Advise smoking patients to quit10 (3.0)181 (53.5)147 (43.5) Discuss smoking risks and cessation benefits16 (4.7)223 (66.0)99 (29.3) Assess Assess willingness to quit105 (31.0)178 (52.7)55 (16.3) Assist Discuss about previous quit attempts102 (30.2)192 (56.8)44 (13.0) Discuss use of NRT218 (64.5)98 (29.0)22 (6.5) Assist patients set up a quit date181 (53.6)122 (36.0)35 (10.4) Arrange follow up Set follow up appointment194 (57.4)103 (30.5)41 (12.1)

Training on smoking cessation interventions

Attitude towards provision of smoking cessation interventions

Knowledge on smoking cessation interventions Poor knowledge score (0-9): 139 (41%) Average knowledge score (10-14): 171(51%) Good knowledge score (15-20 ): 28 (8%) KNOWLEDGE ITEMCorrect Incorrect / %Don’t know % Knowledge on nicotine dependence and withdrawal symptoms Patients who smoke within 30minutes of waking up are likely to be less dependent on nicotine as compared to those who smoke much later in the day Knowledge of recommended cessation medications Nicotine gum Nicotine patch Nicotine lozenge1882 Bupropion tablets

13 Organizational support in provision of smoking cessation interventions

14 Predictive factors for better practice scores Predictor variableClassificatio n Odds95% C.I. for OR ratioLowerUpper p value Knowledge levelPoor^ Average Good Attitude levelsNegative^ Positive SexFemale^ Male Training StatusNo^ Yes Organizational support No^ Yes

DISCUSSION & CONCLUSION Most health care workers did not routinely provide smoking cessation care to patients Findings were comparable to similar studies in Africa. In a study among HCP in Egypt, only 36% of the HCP stated that they always advised their patients to quit smoking (Eldein, et al 2013) There was inadequate organizational support to facilitate increased involvement of healthcare workers in providing smoking cessation care to patients Smokers who turn to the health system may not be offered smoking cessation interventions because health care workers have inadequate knowledge, techniques and organizational support to deal with a smoker who wants to quit.

16 Recommendations Fast track implementation of a pre-service and in- service standard curriculum for training HCP’s on smoking cessation ( role of e- Learning) Dissemination of guidelines for screening, documentation and treatment of tobacco dependence by the Ministry of health and County governments MOH & County government should provide support to HCP in provision of smoking cessation interventions e.g. IEC materials, referral mechanisms for intensive support, system prompts for smoker identification and cessation medications

ACKNOWLEDGEMENTS KMA Center for Tobacco control in Africa International Development Research Centre- (IDRC) – Canada Mentors - Prof Elizabeth Ngugi - Ms Rose Opiyo

THANK YOU !