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      Smoking cessation knowledge, attitude and practices among tuberculosis physicians: A qualitative study

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          Abstract

          INTRODUCTION

          Smoking cessation interventions within tuberculosis (TB) care are feasible, effective and efficient for increasing smoking cessation rates. We aimed to assess TB physicians’ smoking cessation knowledge, attitude, and practices (KAP).

          METHODS

          We conducted a qualitative study with 21 TB physicians and utilized directed deductive content analysis with predefined knowledge, attitude, and practice categories. Physicians’ practice was analyzed using the ABC approach (Ask, Brief advice, and Cessation support).

          RESULTS

          Physicians acknowledged the importance of quitting for improved treatment outcomes and decreased risk of TB relapse. Physicians revealed presumed drug interactions, possible side effects of pharmacotherapy, and reluctance to take additional medications as challenges of smoking cessation interventions. Physicians asked about smoking behavior and provided a brief quitting advice to TB patients; however, implementation of cessation support was limited due to poor knowledge of evidence-based cessation methods and the absence of formal tobacco dependence treatment algorithms within TB care.

          CONCLUSIONS

          TB physicians’ KAP on smoking cessation was limited. Interventions targeting physicians’ knowledge and skills, and formalization of tobacco dependence treatment within TB care, are core for improving their smoking cessation practices in Armenia.

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          Three approaches to qualitative content analysis.

          Hsiu-Fang Hsieh, Sarah Shannon (2016)
          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis.

            Michael Bates, Asheena Khalakdina, Madhukar Pai … (2007)
            There is no consensus whether tobacco smoking increases risk of tuberculosis (TB) infection, disease, or mortality. Whether this is so has substantial implications for tobacco and TB control policies. To quantify the relationship between active tobacco smoking and TB infection, pulmonary disease, and mortality using meta-analytic methods. Eight databases (PubMed, Current Contents, BIOSIS, EMBASE, Web of Science, Centers for Disease Control and Prevention Tobacco Information and Prevention Source [TIPS], Smoking and Health Database [Institute for Science and Health], and National Library of Medicine Gateway) and the Cochrane Tobacco Addiction Group Trials Register were searched for relevant articles published between 1953 and 2005. Included were epidemiologic studies that provided a relative risk (RR) estimate for the association between TB (infection, pulmonary disease, or mortality) and active tobacco smoking stratified by (or adjusted for) at least age and sex and a corresponding 95% confidence interval (CI) (or data for calculation). Excluded were reports of extrapulmonary TB, studies conducted in populations prone to high levels of smoking or high rates of TB, and case-control studies in which controls were not representative of the population that generated the cases, as well as case series, case reports, abstracts, editorials, and literature reviews. Twenty-four studies were included in the meta-analysis. Extracted data included study design, population and diagnostic details, smoking type, and TB outcomes. A random-effects model was used to pool data across studies. Separate analyses were performed for TB infection (6 studies), TB disease (13 studies), and TB mortality (5 studies). For TB infection, the summary RR estimate was 1.73 (95% CI, 1.46-2.04); for TB disease, estimates ranged from 2.33 (95% CI, 1.97-2.75) to 2.66 (95% CI, 2.15-3.28). This suggests an RR of 1.4 to 1.6 for development of disease in an infected population. The TB mortality RRs were mostly below the TB disease RRs, suggesting no additional mortality risk from smoking in those with active TB. The meta-analysis produced evidence that smoking is a risk factor for TB infection and TB disease. However, it is not clear that smoking causes additional mortality risk in persons who already have active TB. Tuberculosis control policies should in the future incorporate tobacco control as a preventive intervention.
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              Physician advice for smoking cessation.

              Lindsay Stead, Diana Buitrago, Nataly Preciado … (2013)
              Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013. Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow-up.The main outcome measure was abstinence from smoking after at least six months follow-up. We also considered the effect of advice on mortality where long-term follow-up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow-up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (CI) 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow-up. Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Tob Prev Cessat
                Journal ID (iso-abbrev): Tob Prev Cessat
                Journal ID (publisher-id): TPC
                Title: Tobacco Prevention & Cessation
                Publisher: European Publishing on behalf of the European Network for Smoking and Tobacco Prevention (ENSP)
                ISSN (Electronic): 2459-3087
                Publication date (Electronic): 21 December 2020
                Publication date Collection: 2020
                Volume: 6
                Electronic Location Identifier: 70
                Affiliations
                [1 ]Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
                Author notes
                CORRESPONDENCE TO Arusyak Harutyunyan. Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave, 0019, Yerevan, Armenia. E-mail: aharutyunyan@ 123456aua.am
                Article
                Publisher ID: 70
                DOI: 10.18332/tpc/130475
                PMC ID: 7762926
                PubMed ID: 33409424
                SO-VID: 4c18a799-cdc4-46aa-9b93-cc4da9a3e95c
                Copyright © © 2020 Harutyunyan A. et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License.

                History
                Date received : 30 July 2020
                Date revision received : 11 November 2020
                Date accepted : 14 November 2020
                Categories
                Subject: Research Paper

                Keywords: abc approach,smoking cessation,tuberculosis,kap,tobacco control,healthcare providers
                Data availability:
                Keywords: abc approach, smoking cessation, tuberculosis, kap, tobacco control, healthcare providers

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