Muramoto Myra L, Howerter Amy, Eaves Emery R, Hall John R, Buller David B, Gordon Judith S
University of Arizona, Department of Family & Community Medicine, Tucson, AZ, United States.
JMIR Res Protoc. 2016 Jan 6;5(1):e2. doi: 10.2196/resprot.5061.
Complementary and alternative medicine (CAM) practitioners, such as chiropractors, acupuncturists, and massage therapists, are a growing presence in the US health care landscape and already provide health and wellness care to significant numbers of patients who use tobacco. For decades, conventional biomedical practitioners have received training to provide evidence-based tobacco cessation brief interventions (BIs) and referrals to cessation services as part of routine clinical care, whereas CAM practitioners have been largely overlooked for BI training. 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 remains underdeveloped.
In pursuit of a long-term goal of helping CAM practitioners integrate evidence-based practices from US Public Health Service Tobacco Dependence Treatment Guideline into routine clinical care, this pilot protocol aims to develop and test a Web-based tobacco cessation training program tailored for CAM practitioners.
In preparation for a larger trial to examine the effect of training on CAM practitioner clinical practice behaviors around tobacco cessation, this developmental study will (1) adapt an existing in-person tobacco cessation BI training program that is specifically tailored for CAM therapists for delivery via the 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 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 qualitative and quantitative formative research on factors influencing practitioner tobacco cessation clinical behaviors (eg, practice environment, peer social influence, and insurance reimbursement).
Web-training and competency assessment tool development and study enrollment and training activities are complete (N=203 practitioners enrolled). Training completion rates were lower than expected (36.9%, 75/203), necessitating over enrollment to ensure a sufficient number of training completers. Follow-up data collection is in progress. Data analysis will begin immediately after data collection is complete.
To realize CAM practitioners' potential to promote tobacco cessation and use of evidence-based treatments, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors (eg, social influence and insurance reimbursement). 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. The potential impact of this study is to expand tobacco cessation and health promotion infrastructure in a new group of health practitioners who can help combat the continuing epidemic of tobacco use.
整脊治疗师、针灸师和按摩治疗师等补充和替代医学（CAM）从业者在美国医疗保健领域的影响力日益增大，已经为大量吸烟患者提供健康保健服务。几十年来，传统生物医学从业者接受过相关培训，能够在常规临床护理中提供基于证据的戒烟简短干预（BIs）并推荐戒烟服务，而CAM从业者在很大程度上被忽视了BI培训。基于网络的培训显然有潜力满足大规模培训传播的需求。然而，尽管针对卫生专业人员的基于网络的培训使用激增，但基于网络的临床技能能力评估仍未得到充分发展。
为了实现帮助CAM从业者将美国公共卫生服务部烟草依赖治疗指南中的循证实践纳入常规临床护理这一长期目标，本试验方案旨在开发并测试一个为CAM从业者量身定制的基于网络的戒烟培训项目。
为了准备一项更大规模的试验，以检验培训对CAM从业者围绕戒烟的临床实践行为的影响，本发展性研究将：（1）改编现有的专门为CAM治疗师量身定制的面对面戒烟BI培训项目，以便通过互联网进行授课；（2）开发一种新颖的基于网络的工具，以评估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现场视频角色扮演进行比较；（3）对120名CAM从业者（40名针灸师、40名整脊治疗师、40名按摩治疗师）进行基于网络的培训试点测试，以评估其可用性、可及性、可接受性，以及对从业者戒烟知识、自我效能和能力的影响；（4）对影响从业者戒烟临床行为的因素（如执业环境、同行社会影响和保险报销）进行定性和定量的形成性研究。
网络培训和能力评估工具的开发以及研究招募和培训活动均已完成（共招募203名从业者）。培训完成率低于预期（36.9%，75/203），因此需要超额招募以确保有足够数量的培训完成者。后续数据收集正在进行中。数据收集完成后将立即开始数据分析。
为了发挥CAM从业者在促进戒烟和使用循证治疗方面的潜力，有必要更多地了解影响CAM从业者烟草干预行为的促进因素和抑制因素（如社会影响和保险报销）。鉴于传统从业者和CAM从业者之间存在显著差异，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从业者身上。本研究的潜在影响是在一组新的卫生从业者中扩大戒烟和健康促进基础设施，这些从业者可以帮助应对持续的烟草使用流行问题。
