Online Tobacco Cessation Training & Competency Assessment for CAM Practitioners

摘要尽管几十年的公共卫生努力，烟草使用仍然是美国主要的可预防的死亡原因。随着美国人口中使用补充和替代医学（CAM）的比例显著增加，CAM从业者是美国卫生系统的重要组成部分。然而，这些从业者在很大程度上被排除在促进健康生活方式行为的国家公共卫生议程之外。为了解决公共卫生政策的这一差距，亚利桑那大学的研究人员开发了一种面对面的戒烟BI培训和办公室系统干预，专门为针灸师、脊椎按摩师和按摩治疗师（CAM从业者）的独特需求量身定制，作为当前nci资助的CAM Reach项目（CAMR）的一部分。CAMR的长期目标是帮助所有的脊医、针灸师和按摩治疗师将PHS烟草依赖治疗指南中的建议整合到他们的日常实践中。随着戒烟培训项目的发展，这一雄心勃勃的目标将更加可行，这些项目是为辅助医学从业者量身定制的，可获得的，可接受的，可扩展的。基于网络的培训显然具有满足大规模培训传播需要的潜力。然而，尽管对卫生专业人员进行基于网络的培训爆炸式增长，但基于网络的临床技能能力评估仍不完善。为了发挥辅助医疗从业人员促进戒烟和使用指南治疗的潜力，需要更多地了解影响辅助医疗从业人员烟草干预行为的促进和抑制因素，例如社会影响和保险报销。戒烟BI服务的保险报销现在广泛适用于常规医疗从业人员，但与保险公司有关联的辅助医学从业人员并非如此。鉴于传统从业者和辅助医学从业者之间的显著差异，现有的关于影响传统从业者采取戒烟行为的因素的知识不能自信地外推到辅助医学从业者。因此，为了准备更大规模的传播试验，以检查培训和报销对辅助医学从业者戒烟做法的影响，本发展建议的具体目标是：1)改编现有的专门为脊椎指压治疗师、针灸师和按摩治疗师量身定制的面对面戒烟简短干预培训计划，通过互联网提供；2)开发一种新颖的基于网络的工具，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，将能力评估工具与标准化患者的实时视频角色扮演进行比较。3)以120名CAM从业者（40名针灸师、40名脊医、40名按摩治疗师）为对象，对基于网络的CAMR培训进行试点测试，考察其可用性、可及性、可接受性以及对从业者知识、自我效能感和戒烟能力的影响；4)对影响从业者戒烟行为的因素进行混合方法形成性研究，重点关注：实践环境、同伴社会影响、保险报销。

DESCRIPTION (provided by applicant): Online tobacco cessation training & competency assessment for CAM practitioners Abstract Despite decades of public health efforts tobacco use remains the leading preventable cause of death in the US. As a significant and increasing proportion of the US population utilizes complementary and alternative medicine (CAM), CAM practitioners are a critical part of the US health system. Yet these practitioners have been largely left out of the nation's public health agenda promoting healthy lifestyle behaviors. To address this gap in public health policy, University of Arizona researchers have developed an in-person tobacco cessation BI training and office system intervention specially tailored for the unique needs of acupuncturists, chiropractors, and massage therapists (CAM practitioners) as part of the current NCI-funded CAM Reach Project (CAMR). The long-term goal of CAMR is to help all chiropractors, acupuncturists, and massage therapists to integrate recommendations from the PHS tobacco dependence treatment guideline into their routine practice. This ambitious goal will be more feasible with development of cessation training programs, tailored for CAM practitioners, which are accessible, acceptable, and scalable. 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 is still under developed. To realize CAM practitioners' potential to promote tobacco cessation and use of guideline-based treatment, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors, e.g. social influence and insurance reimbursement. Insurance reimbursement for tobacco cessation BI services is now widely available for conventional medical practitioners, but this is not the case for CAM practitioners affiliated with insurers. 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. Thus, in preparation for a larger dissemination trial to examine the effect of trainng and reimbursement on CAM practitioner cessation practices, the Specific Aims of this developmental proposal are to: 1) Adapt an existing in-person tobacco cessation brief intervention training program that is specifically tailored for chiropractors, acupuncturists, and massage therapists for delivery via 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 CAMR 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 mixed methods formative research on factors influencing practitioner tobacco cessation behaviors, focusing on, practice environment, peer social influence, and insurance reimbursement.