Factors associated with the implementation of the 5A’s C Martínez, Y Castellano, A Andrés, M Fu, L Antón, M Ballbè, P Fernández, S Cabrera, A Riccobene, E Gavilan, T Baena-García, M Margalef y E Fernández Cristina Martinez Martinez cmartinez@iconcologia.net @CrisMarMar * No conflcts of interest

Background Several health organizations have adopted the 5A’s model, following evidence-based guidelines for smoking cessation: “Ask” “Advice” “Assess” “Assist” “Arrange a follow-up”

Aims Describe the level of implementation of the 5A’s among health workers in Catalonia. Investigate how several factors interact and potentially predict the implementation of each component of the 5A’s: Individual Cognitive Behavioral Organizational

Methods Design: Cross-sectional study. Subjects: Professionals from the Catalan Hospitals 2014-5 (n=702). Questionnaire: 63 questions; tested on 10 subjects Level of implementation of the 5A’s Individual factors: sex, profession, smoking consumption, previous training Cognitive and Behavioral: 1) motivation, 2) knowledge about tobacco cessation, 3) self-efficacy, 4) importance of providing tobacco use interventions, 5) effectiveness of interventions, 6) importance of barriers, and 7) preparedness (Sheffer 2009) Organizational: having records, systematic protocols, access to tobacco cessation pharmacological aids, using additional resources to intervene . Items 0=“nothing” a 10=“completely” Analysis: Descriptive and bivariate (U Mann-Whitney and Kruskal-Wallis ) Multivariate analysis: Implementation predictors (OR; 95% CI)

Results Figure 1: Descripción of the sample (n=702) Profession* Doctors Nurses Others Sex * Men Women Age * < 40 years ≥ 40 years Experience < 14 years ≥ 14 years Smoking consumption * Smokers None smokers Place of work * Hospital Other Training * Yes No % * Estadísticamente significativo

Figure 2 :Level of implementation of the 5A’s Score Reposición: Sólo se tiene información de 752 casos (72% del total de 1.047) de los cuales el 42% es por reposición (mín: 16%, máx: 84%)

Figure 2 :Level of implementation of the 5A’s Score Doctors Nurses Others Reposición: Sólo se tiene información de 752 casos (72% del total de 1.047) de los cuales el 42% es por reposición (mín: 16%, máx: 84%) * Statistically significant

Figure 3: Implementation of the 5A’s by smoking consumpiton Score * Statistically significant

Figure 4: Implementation of the 5A’s by training Score Yes No * Statistically significant

Figure 5. Correlation between the 5A’s * Statistically significant

Figure 6.1: Predictors of the implementation of each componenent of the 5A’s Tobacco consumption (Never smoker) Smoker Former smoker Profession (Others) Doctors Nurses Cognitive factors Motivated to help smokers to quit Impotence of smoking cessation in his/her work Self-reported preparedness Self-reported preparedness with drugs Competence in helping smokers to quit Security in motivating patients Wish more training It’s part of his/her job Lack of knowledge and abilities Behavioral Factors Uses several resources See patients with tobacco-related diseases Familiar with resources (quit lines, Internet, etc ) Previous positive experiences Organizational factors It is ask for his/her managers Organizational support Has positive support from their supervisors

Figure 6.1: Predictors of the implementation of each componenent of the 5A’s Tobacco consumption (Never smoker) Smoker Former smoker Profession (Others) Doctors Nurses Cognitive factors Motivated to help smokers to quit Impotence of smoking cessation in his/her work Self-reported preparedness Self-reported preparedness with drugs Competence in helping smokers to quit Security in motivating patients Wish more training It’s part of his/her job Lack of knowledge and abilities Behavioral Factors Uses several resources See patients with tobacco-related diseases Familiar with resources (quit lines, Internet, etc ) Previous positive experiences Organizational factors It is ask for his/her managers Organizational support Has positive support from their supervisors

Limitations Strenghts Convenience sample (health professionals interested in receiving training) Self reported data (Compliance bias) Strenghts First study about the implementation of the 5A’s in hospitals Includes several factors described in the literature Sample size wide for subgroup analysis (n= 702) Participación de los pacientes: Sólo se tiene información de 752 casos (72% del total de 1.047) de los cuales el 58% son de primera opción (mín: 16%, máx: 84%)

Conclusions The 5A’s model is not fully implemented High level of correlation between (Ask, Advice, Asses) and (Assist and Arrange) Facilitators of the implementations: Positive previous experience Consider oneself as competent Elements for improvement: Provide practical training (↑ abilities, ↑ knowledge) Provide organizational support (recognitions, part of his/her work)

Factors associated with the implementation of the 5A’s C Martínez, Y Castellano, A Andrés, M Fu, L Antón, M Ballbè, P Fernández, S Cabrera, A Riccobene, E Gavilan, T Baena-García, M Margalef y E Fernández Cristina Martinez Martinez cmartinez@iconcologia.net @CrisMarMar * No conflcts of interest