Online Tobacco Cessation Training and Competency Assessment for Complementary and Alternative Medicine (CAM) Practitioners: Protocol for the CAM Reach Web Study

Abstract

BackgroundComplementary 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.ObjectiveIn 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.MethodsIn 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).ResultsWeb-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.ConclusionsTo 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...

Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study

“…A search of MT training on PubMed and Google Scholar revealed that most articles focus on massage therapy as an intervention and the health outcomes of massage. Few scholarly articles addressed training MTs for a specific skill following their primary professional education [15,16]. Muramoto et al [16] were the first to successfully develop and implement e-training (BBI training and competency evaluation) of complementary and alternative medicine providers (including MTs) for screening clients for tobacco use and encouraging tobacco cessation.…”

“…Guided by our conceptual framework and formative data collection, we adapted content from 2 existing Web-based training programs: (1) a multimedia skin cancer risk reduction academic course, currently tailored for university students in the health sciences [20] and (2) MT client-centered communication and referral skills modules used in a BBI training for tobacco cessation [16].…”

“…We endeavored to provide MTs with a refresher of the information some may have received during their professional training, while focusing on content for the expected MT-client interaction and helping conversation. We adapted client-centered communication and referral skills content from previous studies that trained MTs to offer their clients helping conversations and referrals addressing tobacco cessation [15,16]. The 4 steps of a helping conversation as applied to skin cancer, awareness, understanding, helping, and relating, are described in Table 1.…”

“…Using procedures and cases from our previous BBI research [16], we developed electronic simulations of case-based practice of communication skills and application of skin cancer risk reduction knowledge using the Kynectiv DecisionSim [22] platform. Each case comprises skin cancer–focused scenarios that simulate MT decision making during a helping conversation.…”

“…In our prior work with MTs, we conducted in-person and Web-based tobacco cessation brief behavioral intervention (BBI) training for nonbiomedical health care practitioners (including MTs) in private practice contexts [15,16]. This electronic training (e-training) significantly increased practitioners’ use of client-centered communication, BBI, and referral skills in the form of offering clients a helping conversation .…”