Abstract
Objective: To determine the impact of stage-based smoking cessation workshops for perinatal care-providers.
Methods: A one-day workshop was designed and piloted with perinatal care-providers in Comox Valley, British Columbia. Dissemination to eight other communities followed. Preand post-questionnaires were collected from 270 care-providers. Clients (n=115) were interviewed after contact with a care-provider.
Results: Workshops increased care-provider knowledge (p<0.0001), confidence to address smoking with clients (p<0.0001), and perceived ability to help clients across the stages of change (p<0.0001). There was an increase in use of the model (p<0.0001) by careproviders, with 86% reporting changing their work with perinatal clients and 75% applying it beyond that setting. A significant shift in client readiness to change occurred during the pilot (p=0.001) and dissemination (p=0.013). Eighty percent of dissemination clients reported altering smoking behaviours as a result of intervention and 36% made at least one attempt to quit. Client satisfaction was high. Spin-off benefits included increased community collaboration, and capacity.
Résumé
Objectif: Déterminer l’influence d’une conférence, à l’intention du personnel soignant, sur l’arrêt du tabac chez les femmes enceintes.
Méthode: Nous avons conçu un atelier-pilote d’une journée, qui a été mené par des soignants périnataux dans la vallée de Comox en Colombie-Britannique, puis étendu à huit autres collectivités. Deux cent soixante-dix participants ont rempli des questionnaires avant et après l’atelier. Les clientes (n = 115) ont été interviewées par un participant à l’atelier.
Résultats: Les ateliers ont accru les connaissances des soignants (p < 0,0001), leur ont permis de parler du problème de la cigarette avec leurs clientes avec beaucoup plus de confiance (p < 0,0001) et leur ont donné la possibilité d’accroître leur aide tout au long des stages du traitement (p < 0,0001). Il y a eu une augmentation significative de l’utilisation du modèle (p < 0,0001) par les soignants: 86 % ont déclaré un changement dans leur travail avec les clientes périnatales, et 75 % ont appliqué ce modèle au-delà du cadre. On a constaté une évolution significative de l’ouverture des clientes au changement à l’étape pilote (p < 0,0001) et durant les ateliers ultérieurs (p = 0,013). Quatre-vingt p. cent des clientes des ateliers ultérieurs ont indiqué que leur utilisation du tabac avait changé en raison de l’intervention, et 36 % au moins ont essayé d’arrêter de fumer. La satisfaction des clientes était très élevée.
Footnotes
Acknowledgements: This project received support from the Community Action Initiatives Program, Tobacco Demand Reduction Strategies, Health Canada, Canadian Cancer Society, BC and Yukon Division, Upper Island/Central Coast Community Health Services Society, and BC Heart Health Demonstration Project, BC Ministry of Health Planning. The authors thank Kris Welk and Julie McCaig for their valuable assistance and acknowledge the efforts of all the perinatal women, their care-providers, and other dedicated community members who were involved in many aspects of this project.
References
- 1.Edwards N, Sims-Jones N, Hotz S. Pre and Postnatal Smoking: A Review of the Literature. Ottawa: Health Canada; 1994. [Google Scholar]
- 2.Connor FK, McIntyre L. The social demographic predictors of smoking cessation among pregnant women in Canada. Can J Public Health. 1999;90(5):352–55. doi: 10.1007/BF03404527. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: Applications to addictive behaviours. Am Psychol. 1992;47(9):1102–14. doi: 10.1037/0003-066X.47.9.1102. [DOI] [PubMed] [Google Scholar]
- 4.Caffarella RS. Planning Programs for Adult Learners: A Practical Guide for Educators, Trainers, and Staff Developers. San Francisco: Jossey-Bass; 1994. [Google Scholar]
- 5.Schoenly L. Teaching in the affective domain. J Contin Educ Nursing. 1994;25(5):109–12. doi: 10.3928/0022-0124-19940901-06. [DOI] [PubMed] [Google Scholar]
- 6.Windsor RA, Cutter G, Morris J, et al. The effectiveness of smoking cessation methods for smokers in public health maternity clinics: A randomized trial. Am J Public Health. 1985;75:1389–92. doi: 10.2105/AJPH.75.12.1389. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Windsor RA, Lowe JB, Perkins LL, et al. Behaviour impact and cost benefit of health education methods for pregnant smokers in public health maternity clinics: The Birmingham Trial II. Am J Public Health. 1993;83:201–6. doi: 10.2105/AJPH.83.2.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Hjalmarson AIM, Hahn L, Svanberg B. Stopping smoking in pregnancy: Effect of a self-help manual in controlled trial. Br J Obstet Gynaecol. 1991;98:260–64. doi: 10.1111/j.1471-0528.1991.tb13390.x. [DOI] [PubMed] [Google Scholar]
- 9.Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. Standardized, individualized, interactive and personalized self-help programs for smoking cessation. Health Psychology. 1993;12(5):399–405. doi: 10.1037/0278-6133.12.5.399. [DOI] [PubMed] [Google Scholar]
- 10.Glynn TJ, Boyd GM, Gruman JC. Essential elements of self-help/minimal intervention strategies for smoking cessation. Health Educ Q. 1990;17:335–41. doi: 10.1177/109019819001700308. [DOI] [PubMed] [Google Scholar]
- 11.Wynn M. Stopping When You’re Ready. Ottawa: Community Health Research Unit, University of Ottawa; 1995. [Google Scholar]
- 12.McDowell N, McKenna J, Naylor PJ. Factors that influence practice nurses to promote physical activity. Br J Sports Med. 1997;31(4):308–13. doi: 10.1136/bjsm.31.4.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.DiClemente CC, Prochaska JO, Fairhurst S, et al. The process of smoking cessation: An analysis of precontemplation, contemplation and contemplation/action. J Consult Clin Psychol. 1991;59:295–304. doi: 10.1037/0022-006X.59.2.295. [DOI] [PubMed] [Google Scholar]
- 14.Velicer WF, Fava JL, Prochaska JO, et al. Distribution of smokers by stage in three representative samples. Prev Med. 1995;24:401–11. doi: 10.1006/pmed.1995.1065. [DOI] [PubMed] [Google Scholar]
- 15.Munro BH, Page EB. Statistical Methods for Health Care Research. 2nd. Philadelphia: JB Lippincott; 1993. p. 94. [Google Scholar]
- 16.Schwartz J. Review and Evaluation of Smoking Control Methods: The United States and Canada, 1978–1985. 1987. [Google Scholar]
- 17.Adams JES. Facilitating Changes in Perinatal Smoking: A Community Development Approach. Antigonish, Nova Scotia: St. Francis Xavier University; 1999. [Google Scholar]
- 18.Hawe P, Noort M, King L, Jordens C. Multiplying health gains: The critical role of capacity-building within health promotion programs. Health Policy. 1997;37:29–42. doi: 10.1016/S0168-8510(96)00847-0. [DOI] [PubMed] [Google Scholar]