Institute of Social Medical Studies, Hanoi, Vietnam.
Department of Population Health, New York University School of Medicine, New York, NY, USA.
Glob Health Promot. 2020 Sep;27(3):24-33. doi: 10.1177/1757975919854032. Epub 2019 Jul 18.
Community health workers (in Vietnam referred to as village health workers) have the potential to play a key role in expanding access to evidence-based tobacco use treatment. We conducted a cluster randomized controlled trial in community health centers in Vietnam that compared the effect of provider advice and cessation assistance (i.e. brief counseling and patient education materials) (BC) vs. BC + three sessions of in-person counseling delivered by a village health worker (BC+R) on providers' and village health workers' adherence to tobacco use treatment guidelines. All village health workers and health care providers received training. This paper presents data on the effect of the intervention on village health workers' adherence to tobacco use treatment guidelines, including asking about tobacco use, advising smokers to quit, offering assistance and their attitude, norms, and self-efficacy related to tobacco use treatment. We examined changes in adherence to tobacco use treatment guidelines before and 12 months after the intervention among 89 village health workers working in the 13 community health centers enrolled in the BC+R study condition. Village health workers' adherence to tobacco use treatment guidelines increased significantly. Village health workers were more likely to ask about tobacco use (3.4% at baseline, 32.6% at 12 months), offer advice to quit (4.5% to 48.3%) and offer assistance (1.1% to 38.2%). Perceived barriers to treating tobacco use decreased significantly. Self-efficacy and attitudes towards treating tobacco use improved significantly. Increased adherence to tobacco use treatment guidelines was associated with positive attitudes towards their role in delivering tobacco use treatment and increasing awareness of the community health center smoke-free policy. The findings suggest that, with training and support systems, village health workers can extend their role to include smoking cessation services. This workforce could represent a sustainable resource for supporting smokers who wish to quit.
社区卫生工作者（在越南称为乡村卫生工作者）有可能在扩大获得基于证据的烟草使用治疗方面发挥关键作用。我们在越南的社区卫生中心进行了一项集群随机对照试验，比较了提供建议和戒烟辅助（即简短咨询和患者教育材料）（BC）与 BC+由乡村卫生工作者提供的三次面对面咨询（BC+R）对提供者和乡村卫生工作者遵守烟草使用治疗指南的效果。所有乡村卫生工作者和卫生保健提供者都接受了培训。本文介绍了干预对乡村卫生工作者遵守烟草使用治疗指南的影响的数据，包括询问烟草使用情况、建议吸烟者戒烟、提供帮助以及与烟草使用治疗相关的态度、规范和自我效能。我们在参加 BC+R 研究条件的 13 个社区卫生中心工作的 89 名乡村卫生工作者中，检查了干预前和干预后 12 个月对烟草使用治疗指南的遵守情况。乡村卫生工作者对烟草使用治疗指南的遵守程度显著提高。乡村卫生工作者更有可能询问烟草使用情况（基线时为 3.4%，12 个月时为 32.6%）、提供戒烟建议（从 4.5%到 48.3%）和提供帮助（从 1.1%到 38.2%）。治疗烟草使用的感知障碍显著降低。治疗烟草使用的自我效能和态度显著改善。对烟草使用治疗指南的更高遵守率与对其在提供烟草使用治疗方面的作用的积极态度以及对社区卫生中心无烟政策的认识提高有关。这些发现表明，通过培训和支持系统，乡村卫生工作者可以扩大其角色，包括提供戒烟服务。这支劳动力队伍可能是支持希望戒烟的吸烟者的可持续资源。
