Tailored Internet Program to Improve OB Providers' Smoking Cessation Counseling

描述(申请人提供)：孕妇吸烟对婴儿有危险；然而，多达三分之一的妇女在怀孕期间继续吸烟。产科提供者被收取帮助女性戒烟的费用。然而，大多数提供者还没有学习到最有效的咨询方法。培训OB提供商的计划必须便于繁忙的提供商使用，并且在不需要提供商投入大量时间的情况下有效。在这项应用中，我们建议开发医疗技术，以提高产科护理人员的戒烟咨询技能。幸运的是，存在有效的、基于证据的提供者咨询策略，如5A-询问、建议、评估、协助和安排。然而，教学5A的有效方法仍然存在，即通过书面指导或说教演示。即使提供者可能已经接受了这些其他教育资源，但大多数产科护理提供者只询问和建议，这是5A中最不重要的两个要素。如果采用有效的方法，提供者可以学习特定的沟通技能50-59，从而改善健康结果。50、59、60拟议的干预使用基于互联网的互动培训计划，其中结合了提供者自己的戒烟咨询交流的例子，从实际的产科录音访问。这一干预措施的设计解决了几个关键因素，这些因素是对执业OB提供者进行成功的培训干预的关键。62、63首先，执业临床医生需要他们可以在繁忙的日程安排中纳入的计划。64-66这项培训应该简短、易于访问，并且不会干扰他们的实践。其次，干预需要有理论基础，并符合教育原则。互动式继续医学教育被评为教授新技能和临床实践的最佳方法之一69、79、80，并已被证明能提高学习者的留存和满意度。81最后，培训需要与提供者相关。62 63、65、67与个人有关的信息得到更多的关注、更仔细的处理和更长的保留时间。供应商还需要对沟通的反馈，而不能仅仅通过被告知使用哪些技能来学习。供应商往往不准确地评估他们的技能能力水平，只有通过反馈，他们才能提高。我们已经从产科提供者那里收集了实际接触的录音。我们还创建了两个类似的干预措施，一个针对初级保健医生解决体重问题，另一个针对肿瘤学家解决负面情绪问题。因此，我们正在当前工作的基础上再接再厉。为了发展这一干预措施，我们将使用我们的录音，在产科提供者和他们的吸烟孕妇之间进行第一次产科探视。我们将调整针对体重的初级保健干预措施，以解决产前吸烟问题。然后，我们将在产科服务中试行这一干预措施，并评估可用性、可接受性、满意度和潜在影响。一旦我们的第一阶段目标成功，我们将申请第二阶段资金，以测试这一干预的效果。

DESCRIPTION (provided by applicant): Smoking among pregnant women poses risks to the baby; yet, up to one-third of women continue to smoke during pregnancy. Obstetric providers are charged to help women quit. Most providers, however, have not learned the most effective counseling methods. Programs to teach OB providers must be easy for busy providers to use and effective without much of a time commitment from providers. In this application, we propose to develop medical technology to improve smoking cessation counseling skills among obstetric care providers. Fortunately, effective, evidence-based provider counseling strategies, such as the 5 A's-Ask, Advise, Assess, Assist and Arrange exist. Yet, ineffective methods of teaching the 5 A's exist, namely through written guidelines or didactic presentations. Even though providers might have received these other educational resources, most obstetric care providers only Ask and Advise, two of the least critical elements of the 5 A's. When taught with effective methods, providers can learn specific communication skills50-59 that subsequently lead to improved health outcomes.50, 59, 60 The proposed intervention uses an internet-based, interactive training program that incorporates examples of providers' own smoking cessation counseling communication from actual audio-recorded obstetric visits. The design of this intervention addresses several factors that are keys for a successful training intervention with practicing OB providers.62, 63 First, practicing clinicians need programs they can incorporate into their busy schedules.64-66 This training should be brief, easy to access, and not interfere with their practice. Second, the intervention needs to be theory-based and consistent with educational principles. Interactive continuing medical education is rated as the one of the best methods for teaching new skills and clinical practices69, 79, 80 and has been shown to increase learner retention and satisfaction.81 Finally, the training needs to be relevant to the provider.62 63, 65, 67 Personally relevant information is more attended to, processed more carefully, and retained longer. Providers also need feedback on the communication and cannot learn just from being told which skills to use. Providers tend to inaccurately assess their level of competence with skills, and only with feedback, are they able to improve. We have already collected audio recordings of actual encounters from obstetric providers. We also have created two similar interventions, one for primary care physicians addressing weight and the other for oncologists addressing negative emotion. Thus, we are building on our current work. To develop this intervention, we will use our audio-recorded first obstetric visits between obstetrics providers and their pregnant patients who smoke. We will adapt our primary care intervention that addressed weight to address prenatal smoking. We will then pilot test this intervention among obstetric provides and assess usability, acceptability, satisfaction, and potential impact. Once successful with our Phase I aims, we will apply for Phase II funding to test the efficacy of this intervention.