The Effectiveness of a Computer-Tailored E-Learning Program for Practice Nurses to Improve Their Adherence to Smoking Cessation Counseling Guidelines: Randomized Controlled Trial

Abstract

BackgroundImproving practice nurses’ (PN) adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid PNs in improving their guideline uptake and adherence do not exist yet.ObjectiveThe aim of this study was to assess the effects of a novel computer-tailored electronic learning (e-learning) program on PNs’ smoking cessation guideline adherence.MethodsA Web-based randomized controlled trial (RCT) was conducted in which an intervention group (N=147) with full access to the e-learning program for 6 months was compared with a control group (N=122) without access. Data collection was fully automated at baseline and 6-month follow-up via online questionnaires, assessing PNs’ demographics, work-related factors, potential behavioral predictors based on the I-Change model, and guideline adherence. PNs also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N=1175). To assess the program’s effectiveness in improving PNs’ guideline adherence (ie, overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within PNs. Potential effect moderation by work-related factors and behavioral predictors was also examined.ResultsAfter 6 months, 121 PNs in the intervention group (82.3%, 121/147) and 103 in the control group (84.4%, 103/122) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program’s effect on PNs’ overall guideline adherence (beta=.589; 95% CI 0.111-1.068; PHolm-Bonferroni =.048), indicating a positive program effect on adherence for PNs with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend toward moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for PNs with less favorable scores on behavioral predictors (eg, low baseline self-efficacy) and high levels of counseling experience, the program significantly increased adherence.ConclusionsResults from our RCT showed that among PNs with more than average counseling experience, the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced PNs might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared with less experienced colleagues. Less favorable baseline levels of behavioral predictors among PNs possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by health care professionals (HCPs), it is important to assess how to support a...

Effectiveness of Technology-Enabled Knowledge Translation Strategies in Improving the Use of Research in Public Health: Systematic Review

“…All 8 studies were RCTs, of which 4 were cluster RCTs [ 25 , 27 , 29 , 30 ]. A total of 3 studies were conducted in the United States [ 23 - 25 ], 2 in the Netherlands [ 26 , 28 ], 2 in Canada [ 27 , 30 ], and the remaining study was conducted in China [ 29 ].…”

“…Health professionals recruited in the included studies comprised nurses [ 23 , 26 , 30 ], nurse practitioners [ 23 ], physicians [ 23 ], child care health consultants [ 24 ], physiotherapists [ 30 ], primary health care workers [ 29 ], and public health practitioners [ 30 ]. A further study recruited program managers or coordinators of public health departments [ 27 ] and the remaining study recruited professionals employed in schools, community agencies, and policy-making bodies [ 25 ].…”

“…There was variability in the digital TEKT interventions tested. Overall, 5 of the interventions were web-based training programs aimed at improving nutrition and physical activity knowledge in children [ 24 ], utilizing smoking cessation guidelines [ 26 ], body positivity in children and adolescents [ 30 ], physical activity levels in patients with cardiovascular risk factors [ 28 ], and improving basic public health services knowledge [ 29 ]. The remaining 3 interventions included simulation games to improve communication with patients with mental health disorders [ 23 ], access to digital resource materials on substance abuse prevention programs [ 25 ], and the use of tailored messaging in comparison with knowledge brokering or a web-based registry concerning healthy body weight promotion in children [ 27 ].…”

“…The remaining 3 interventions included simulation games to improve communication with patients with mental health disorders [ 23 ], access to digital resource materials on substance abuse prevention programs [ 25 ], and the use of tailored messaging in comparison with knowledge brokering or a web-based registry concerning healthy body weight promotion in children [ 27 ]. Of the 8 included studies, 6 reported using evidence-based information to develop the intervention or as part of the program [ 23 - 27 , 30 ], including the use of systematic reviews [ 27 ], and previous programs and studies [ 23 - 26 , 30 ]. A full description of the intervention consistent with the TIDieR checklist is provided in Multimedia Appendix 3 [ 23 - 30 ].…”

“…The majority of comparison groups for the included studies were control groups that had no access to the digital TEKT strategies (n=3) [ 23 , 24 , 26 ] or waitlist control group (n=2) [ 28 , 30 ]. A study that aimed at providing information on substance abuse prevention programs compared groups accessing information via CD-ROM or the internet to those who accessed information via printed materials [ 25 ].…”