Health Care Workers’ Knowledge, Attitudes and Practices on Tobacco Use in Economically Disadvantaged Dominican Republic Communities

Abstract

Tobacco use is increasing globally, particularly in low and middle-income countries like the Dominican Republic (DR) where data have been lacking. Health care worker (HCW) interventions improve quit rates; asking patients about tobacco use at each visit is an evidence-based first step. This study provides the first quantitative examination of knowledge, attitudes and practices of DR HCWs regarding tobacco use. All HCWs (N = 153) in 7 economically disadvantaged DR communities were targeted with anonymous surveys. Approximately 70% (N = 107) completed the primary outcome item, asking about tobacco use at each encounter. Despite >85% strongly agreeing that they should ask about tobacco use at each encounter, only 48.6% reported doing so. While most (94.39%) strongly agreed that smoking is harmful, knowledge of specific health consequences varied from 98.13% for lung cancer to 41.12% for otitis media. Few received training in tobacco intervention (38.32%). Exploratory analyses revealed that always asking even if patients are healthy, strongly agreeing that tobacco causes cardiac disease, and always advising smoke-free homes were associated with always asking. Overall, results demonstrate a disconnect between HCW belief and practice. Though most agreed that always asking about tobacco was important, fewer than half did so. Gaps in HCW knowledge and practices suggest a need for education and policy/infrastructure support. To our knowledge, this is the first reported survey of DR HCWs regarding tobacco, and provides a foundation for future tobacco control in the DR.

Lessons Learned from Twelve Years of Partnered Tobacco Cessation Research in the Dominican Republic

“…We continue to report findings from PDT studies elsewhere (e.g., Chin, et al in press; Dozier et al, 2006, 2009, 2014; Lando et al 2010; McIntosh, et al, 2008; Ossip-Klein, et al 2008; Ossip, et al; 2013, 2015; Prucha, et al 2015; Torres, et al 2011, 2014; Wipfli, et al 2008). The current paper will report on lessons learned from implementing this US-DR partnered research.…”

“…For example, our data indicated that most healthcare providers were unsure whether patients wanted their advice to quit using tobacco (Prucha et al, 2015), yet 87% of tobacco users reported that this would help. Our investigators shared these results at multiple professional society and healthcare provider workshops and conferences, including trainings for public health workers through the Health Ministry.…”

“…This set the basis for advancing tobacco research in the DR through supervision of over 25 theses from medical and dentistry students on tobacco use (by both DR co-investigators), submitting locally and nationally funded grants, and implementing the first DR national surveillance of tobacco use based on the Global Adult Tobacco Survey (GATS). In addition, PDT provided pre-doctoral research experience to a US team member, leading to a doctoral dissertation on tobacco use and exposure among pregnant women in the DR (Torres, et al 2011), and MPH training to a medical student, leading to a thesis on tobacco knowledge and practices among DR healthcare providers (Prucha, et al, 2015). …”

Estudio de corte transversal sobre el estado de conocimientos, actitudes y prácticas de médicos colombianos ante el tabaquismo

“…Varios estudios recientes demuestran que el personal de la salud no se ve a sí mismo como un ejemplo, mostrando diferentes porcentajes que oscilan entre 44.3% y el 57.89% (16,19,31); mientras que en la implementación del GHPSS se reportó que en países como Cuba, Guatemala y Panamá el 100% de los encuestados está de acuerdo con el rol médico de aconsejar -(3234); por su parte, en Laos el 94.9% de los médicos fumadores y el 97.7% de los exfumadores creen que las posibilidades de que un paciente cese el hábito aumentan si el médico lo aconseja (17).…”

Tobacco intervention research in low- and middle-income countries: lessons learned and future directions

“…The problem is multi-layered: many LMICs have high rates of tobacco use by physicians and other healthcare providers (Abdullah, Qiming, Pun, Stillman, & Samet, 2013, Abdullah et al, 2014; Asfar, Al-Ali, Ward, Vander Weg, & Maziak, 2011), which make them reluctant to champion their patients’ quit attempts. Beyond this motivational issue, many physicians are skeptical that patients want their advice to quit smoking (Ossip et al, 2016; Prucha et al, 2015), do not view cessation as part of their jobs (Dozier et al, 2009; Tee, & Hairi, & Hairi, 2012), and misunderstand the harms of tobacco (Abdullah & Husten, 2004; Asfar et al, 2011; Dogar, Elsey, Khanal, & Siddiqi, 2016; Lando, 2016). …”