Online Tobacco Cessation Training & Competency Assessment for CAM Practitioners

描述(由申请者提供)：针对CAM从业者的在线戒烟培训和能力评估摘要尽管经过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死亡原因。随着越来越多的美国人口使用补充和替代医学(CAM)，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的国家公共卫生议程之外。为了解决公共卫生政策中的这一差距，亚利桑那大学的研究人员开发了面对面的戒烟商务培训和办公室系统干预，作为当前NCI资助的CAM REACH项目(CAMR)的一部分，专门为针灸医生、脊椎按摩师和按摩治疗师(CAM从业者)的独特需求量身定做。CAMR的长期目标是帮助所有脊椎按摩师、针灸医生和按摩治疗师将PHS烟草依赖治疗指南中的建议整合到他们的日常实践中。这一雄心勃勃的目标将随着为CAM从业者量身定做的戒烟培训计划的开发而变得更加可行，这些计划是可访问、可接受和可扩展的。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使用呈爆炸性增长，但基于网络的临床技能能力评估仍处于发展阶段。为了发挥CAM从业者促进戒烟和使用指南治疗的潜力，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，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传统医生，但与保险公司有关联的CAM从业者则不是这样。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。因此，为了准备一项更大的传播试验以检验培训和报销对CAM从业者戒烟实践的影响，该发展提案的具体目标是：1)使现有的专为脊医、针灸和按摩治疗师量身定做的面对面戒烟简短干预培训计划用于通过互联网提供；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名针灸医生、40名脊椎按摩师、40名按摩治疗师)，了解其可用性、可及性、可接受性以及对从业者的知识、自我效能和戒烟能力的影响；4)对影响从业人员戒烟行为的因素进行混合方法的形成性研究，重点是实践环境、同伴社会影响和保险报销。

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.