Tailored Internet Program to Improve OB Providers' Smoking Cessation Counseling

描述（由申请人提供）：孕妇吸烟对婴儿构成风险;然而，多达三分之一的妇女在怀孕期间继续吸烟。产科服务提供者负责帮助妇女戒烟。然而，大多数提供者还没有学会最有效的咨询方法。教授OB提供者的课程必须易于忙碌的提供者使用，并且有效，而不需要提供者投入太多时间。在这个应用程序中，我们建议开发医疗技术，以提高产科护理提供者之间的戒烟咨询技能。幸运的是，有效的，以证据为基础的提供者咨询策略，如5A的问，建议，评估，协助和安排存在。然而，存在无效的5A教学方法，即通过书面指导或教学演示。即使提供者可能已经收到了这些其他的教育资源，大多数产科护理提供者只问和建议，两个最不重要的要素的5A的。当教授有效的方法时，提供者可以学习特定的沟通技巧50 -59，随后导致改善的健康结果。50，59，60拟议的干预措施使用基于互联网的互动培训计划，其中包括提供者自己的戒烟咨询沟通的例子，从实际的音频记录产科访问。这种干预的设计解决了几个因素，这是一个成功的培训干预与执业OB提供者的关键。62，63首先，执业临床医生需要的程序，他们可以纳入他们的忙碌繁忙的业务。64 -66这种培训应该是简短的，易于访问，而不是干扰他们的做法。第二，干预需要以理论为基础，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，并已被证明可以提高学习者的保留率和满意度。81最后，培训需要与提供者相关。62 63，65，67个人相关信息更受关注，处理更仔细，保留时间更长。提供者还需要对沟通的反馈，不能仅仅从被告知使用哪些技能中学习。提供者往往不准确地评估他们的技能能力水平，只有得到反馈，他们才能提高。我们已经从产科医生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，一个是针对初级保健医生解决体重问题，另一个是针对肿瘤学家解决负面情绪问题。因此，我们是在现有工作的基础上再接再厉。为了开发这种干预措施，我们将使用我们的产科提供者和他们的吸烟孕妇之间的第一次产科访问的音频记录。我们将调整我们的初级保健干预措施，解决体重，以解决产前吸烟。然后，我们将在产科提供者中对这种干预进行试点测试，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取得成功，我们将申请第二阶段资金，以测试这种干预措施的有效性。

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.