Online Tobacco Cessation Training and Competency Assessment for Complementary and Alternative Medicine (CAM) Practitioners: Protocol for the CAM Reach Web Study.
Online Tobacco Cessation Training and Competency Assessment for Complementary and Alternative Medicine (CAM) Practitioners: Protocol for the CAM Reach Web Study.
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DOI：
10.2196/resprot.5061
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发表时间：
2016-01-06
影响因子：
1.7
通讯作者：
Gordon JS
中科院分区：
文献类型：
--
作者：
Muramoto ML;Howerter A;Eaves ER;Hall JR;Buller DB;Gordon JS
补充和替代医学(CAM)从业者，如脊椎按摩师、针灸医生和按摩治疗师，在美国医疗保健领域的存在越来越多，已经为大量使用烟草的患者提供健康和健康护理。几十年来，传统的生物医学从业者接受了提供循证戒烟短暂干预(BIS)和转介戒烟服务的培训，作为常规临床护理的一部分，而CAM从业者在BI培训方面基本上被忽视。基于网络的培训具有明显的潜力，可以满足大规模培训传播的需求。然而，尽管对卫生专业人员的基于网络的培训的爆炸性使用，基于网络的临床技能能力评估仍然不发达。为了实现帮助CAM从业者将美国公共卫生服务烟草依赖治疗指南中的循证实践整合到常规临床护理中的长期目标，这一试点方案旨在开发和测试为CAM从业者量身定做的基于网络的戒烟培训计划。为了准备一项更大规模的试验，以检验培训对CAM从业者戒烟临床实践行为的影响，这项发展性研究将(1)调整现有的面对面戒烟BI培训计划，该计划专门为CAM治疗师通过互联网提供；(2)开发一种新的、基于网络的工具来评估CAM从业者在戒烟BI技能方面的能力，并进行一项试点验证研究，将能力评估工具与现场视频角色扮演与标准化患者进行比较；(3)对120名CAM从业者(40名针灸师、40名脊椎按摩师、40名推拿治疗师)进行网上培训，以了解培训的可用性、可达性、可接受性，以及对从业者的戒烟知识、自我效能和戒烟能力的影响；以及(4)对影响从业者戒烟临床行为的因素(如执业环境、同伴社会影响和保险报销)进行定性和定量的形成性研究。网络培训和能力评估工具的开发以及研究登记和培训活动已经完成(N=203名从业人员登记)。培训完成率低于预期(36.9%，75/203)，需要超额招生以确保足够数量的培训完成者。后续数据收集工作正在进行中。数据收集完成后，将立即开始数据分析。为了实现CAM从业者促进戒烟和使用循证治疗的潜力，有必要更多地了解影响CAM从业者烟草干预行为的促进性和抑制性因素(如社会影响和保险报销)。鉴于传统从业者和CAM从业者之间的显著差异，关于影响传统从业者采用戒烟行为的因素的现有知识不能自信地外推到CAM从业者。这项研究的潜在影响是在一个新的健康从业者群体中扩大戒烟和健康促进基础设施，他们可以帮助抗击烟草使用的持续流行。
Complementary and alternative medicine (CAM) practitioners, such as chiropractors, acupuncturists, and massage therapists, are a growing presence in the US health care landscape and already provide health and wellness care to significant numbers of patients who use tobacco. For decades, conventional biomedical practitioners have received training to provide evidence-based tobacco cessation brief interventions (BIs) and referrals to cessation services as part of routine clinical care, whereas CAM practitioners have been largely overlooked for BI training. Web-based training has clear potential to meet large-scale training dissemination needs. However, despite the exploding use of Web-based training for health professionals, Web-based evaluation of clinical skills competency remains underdeveloped. In pursuit of a long-term goal of helping CAM practitioners integrate evidence-based practices from US Public Health Service Tobacco Dependence Treatment Guideline into routine clinical care, this pilot protocol aims to develop and test a Web-based tobacco cessation training program tailored for CAM practitioners. In preparation for a larger trial to examine the effect of training on CAM practitioner clinical practice behaviors around tobacco cessation, this developmental study will (1) adapt an existing in-person tobacco cessation BI training program that is specifically tailored for CAM therapists for delivery via the Internet; (2) develop a novel, Web-based tool to assess CAM practitioner competence in tobacco cessation BI skills, and conduct a pilot validation study comparing the competency assessment tool to live video role plays with a standardized patient; (3) pilot test the Web-based training with 120 CAM practitioners (40 acupuncturists, 40 chiropractors, 40 massage therapists) for usability, accessibility, acceptability, and effects on practitioner knowledge, self-efficacy, and competency with tobacco cessation; and (4) conduct qualitative and quantitative formative research on factors influencing practitioner tobacco cessation clinical behaviors (eg, practice environment, peer social influence, and insurance reimbursement). Web-training and competency assessment tool development and study enrollment and training activities are complete (N=203 practitioners enrolled). Training completion rates were lower than expected (36.9%, 75/203), necessitating over enrollment to ensure a sufficient number of training completers. Follow-up data collection is in progress. Data analysis will begin immediately after data collection is complete. To realize CAM practitioners’ potential to promote tobacco cessation and use of evidence-based treatments, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors (eg, social influence and insurance reimbursement). Given marked differences between conventional and CAM practitioners, extant knowledge about factors influencing conventional practitioner adoption of tobacco cessation behaviors cannot be confidently extrapolated to CAM practitioners. The potential impact of this study is to expand tobacco cessation and health promotion infrastructure in a new group of health practitioners who can help combat the continuing epidemic of tobacco use.