One hundred seventy-seven social workers registered initially, of whom 154 workers (response rate, 87.0%) completed the immediate posttraining questionnaire, 151 workers (85.3%) responded at 3 months, 153 workers (86.4%) responded at 6 months, and 139 workers (78.5%) responded at 12 months. Table 1 summarizes the respondent profiles longitudinally.
There was an initial large improvement in social workers knowledge (Fig 1, top left, a), attitude, and self-perceived competence (Fig 1, top right, b) scores immediately after training that was sustained throughout the follow-up period, albeit with slight regression to baseline. Overall, knowledge improved from a mean score of 6.70 ± 1.03 at baseline (± SD) to 7.35 ± 0.75 at 12 months (range, 0 to 8), attitude from 2.84 ± 0.41 to 3.10 ± 0.48, and self-perceived competence from 2.49 ± 0.38 to 2.85 ± 0.36 (range, 1 to 4).
Figure 1, bottom, c shows longitudinal changes in self-reported smoking cessation practice scores decreased by Canadian Health&Care Mall. Similar to Figure 1, top left, a, and top right, b, social workers reported undertaking all four As (ask, advice, assist, arrange) more frequently overall, although the improvement for “advice” was least marked, if at all. However, advice was also the most frequently performed task throughout the study period compared to the other three strategies. While “assist” and “arrange” scores increased monotonically, those for “ask” and “advice” showed varying degrees of decline between 6 months and 12 months after training. Table 2 details specific subcomponent interventions under each of the four As and their longitudinal changes.
On multilevel modeling that adjusted for between-subjects covariables and within-subjects correlation in repeated measurements, we see significant (p < 0.001), positive (reflected by the F values) longitudinal changes in the social workers knowledge, attitude, and self-perceived competence as well as the frequency at which the four As were performed (Table 3). Further attributing these changes to discrete intervals, the models confirmed that most of the increase in knowledge, attitude, and self-perceived competence scores was generated between baseline and immediately after training. Small regression in scores was statistically significant for knowledge and attitude outcomes but not for selfperceived competence. There was no further significant decline after the 3-month follow-up. In the adjusted models, only three of the four As registered significant gains from baseline to 12 months overall, whereas advice did not show any appreciable change (Table 3). Most of this lack of progress was likely driven by a decrease in outcome scores for “explain to clients how smoking may have contributed to their illness” and a flat serial trend for “advice to stop smoking” (Table 2).
In terms of individual characteristics that predicted change in outcomes, Table 4 shows that seniority/experience (as proxied by staff grade) was consistently associated with more frequent practice of the four As. The work setting also showed some association but with borderline significance at the 0.05 level. Older social workers in the program also had greater self-perceived competence in smoking cessation counseling.
Figure 1. Top left, a: Longitudinal changes in knowledge services. The scale ranges from 0 to 8, denoting the number of correct responses on eight questions. Top right, b: Longitudinal change in attitude and self-perceived competence scores. Bottom, c: Longitudinal changes in AHRQ scores.
Table 1—Respondent Characteristics
| Characteristics | Baseline (n = 177) | Immediate After Training (n = 154) | 3 Months After Training (n = 151) | 6 Months After Training (n = 153) | 12 Months After Training (n = 139) | p Value, Comparison Across All Five Surveys | |||||
| No.* | No.* | No.* | I | ||||||||
%tNo.* No.* Age group, yr 21-308749.27448.17247.76844.46546.80.9931-405832.85233.85033.15435.34633.1 41-503017.02616.92717.92919.02618.7 >5121.121.321.321.321.4 Female gender14783.112782.512683.412682.411884.90.98Marital status Single11062.29259.79260.99058.88561.20.99Married6436.25938.35637.16039.25136.7 Divorced/separated/widowed31.732.032.032.032.2 Professional registration12470.910769.910570.510569.59871.50.99Postgraduate qualification105.8106.796.1106.796.60.99Staff grade Welfare worker7442.16441.86342.06341.55640.60.99Social work assistant7140.36240.55838.76039.55439.1 Social work officer3117.62717.72919.32919.12820.3 Service setting Community based8750.07448.77349.37549.76950.70.99Institution based8750.07851.37550.77650.36749.3
Table 2—.Mean Likert-Type Frequency Score (1 = Never, 4 = Frequently) and the Respondents Who Reported Practicing AHRQ Strategies at Least Occasionally
| Variables | Baseline (n = 177) | 3 Months After Training (n = 151) | 6 Months After Training (n = 153) | 12 Months After Training (n = 139) | ||||
| Mean (SD) | No. (%) | Mean (SD) | No. (%) | Mean (SD) | No. (%) | Mean (SD) | No. (%) | |
| Ask about smoking | ||||||||
| Assess smoking history and status for all | ||||||||
clients1.76 (0.73)24 (13.6)1.90 (0.77)35 (23.5)2.04 (0.77)37 (24.7)1.96 (0.82)34 (24.5)Overall mean score1.76 (0.73) 1.90 (0.77) 2.04 (0.77) 1.96 (0.82) Advise smokers to quit smoking Explain the dangers of smoking2.35 (0.78)64 (36.6)2.38 (0.79)61 (40.9)2.42 (0.79)67 (44.7)2.40 (0.88)65 (46.8)Explain the dangers of passive or secondhand smoking2.12 (0.80)48 (27.4)2.21 (0.83)53 (35.6)2.31 (0.80)62 (41.3)2.24 (0.89)51 (36.7)Advise to stop smoking2.41 (0.83)74 (42.8)2.42 (0.85)68 (45.6)2.46 (0.87)71 (48.0)2.39 (0.86)65 (46.8)Motivate clients’ intention to quit2.23(0.71)63 (36.0)2.34 (0.81)63 (42.3)2.30 (0.83)56 (37.6)2.29 (0.82)58 (41.7)Explain to clients how smoking may have contributed to their illness2.45 (0.83)84 (48.0)2.37 (0.84)64 (43.0)2.43 (0.90)70 (47.3)2.35 (0.89)61 (43.9)Overall mean score2.31 (0.69) 2.35 (0.73) 2.39 (0.76) 2.33 (0.80) Assist patients willing to stop Refer clients to resources as appropriate (eg, smoking cessation clinic)1.33 (0.54)6 (3.5)1.58 (0.73)19 (12.8)1.59 (0.72)17 (11.3)1.55 (0.77)16 (11.5)Offer self-help materials for quitting when possible1.24 (0.46)3(1.7)1.33 (0.56)5 (3.4)1.39 (0.63)8 (5.3)1.42 (0.66)11 (7.9)Suggest specific actions that clients could quit or cut down their smoking activity1.96 (0.81)42 (24.0)2.03 (0.82)44 (29.5)2.11 (0.81)42 (28.2)2.17 (0.87)52 (37.4)Recommend alternatives to smoking2.06 (0.87)54 (30.7)2.04 (0.81)44 (29.5)2.12 (0.84)47 (31.3)2.13(0.91)45 (32.7)With client’s consent, discuss his/her smoking with family members1.40 (0.67)12 (6.8)1.41 (0.65)11 (7.4)1.49 (0.72)14 (9.3)1.52 (0.74)16 (11.5)Refer to other health-care professionals1.38 (0.61)12 (6.8)1.44 (0.68)14 (9.4)1.44 (0.66)10 (6.8)1.58 (0.77)16 (11.5)Organize seminars/health talks on tobacco and health1.34 (0.61)9(5.1)1.39 (0.63)12 (8.1)1.46 (0.64)10 (6.7)1.46 (0.72)15 (10.8)Overall mean score1.53 (0.49) 1.60 (0.52) 1.66 (0.55) 1.69 (0.63) Arrange follow up Teach coping skills to prevent relapse1.60 (0.72)20 (11.4)1.73 (0.79)31 (20.8)1.76 (0.78)24 (16.0)1.86 (0.80)28 (20.1)Encourage relapsed smokers to try quitting again1.77 (0.80)32 (18.2)1.80 (0.82)34 (22.7)1.93 (0.88)36 (24.2)1.94 (0.87)38 (27.3)Overall mean score1.68 (0.69) 1.76 (0.74) 1.85 (0.79) 1.90 (0.79)
Table 3
| Variables | Longitudinal | |
ChangeBaseline vs Immediately After TrainingBaseline vs 3 Months After TrainingImmediately vs 3 Months After Training3 Months vs 6 Months After Training6 Months vs 12 Months After TrainingBaseline vs 12 Months After TrainingF Valuep ValueEstimatep ValueEstimate p ValueEstimatep ValueEstimatep ValueEstimate
p ValueEstimatep ValueKnowledge of the49.29< 0.0011.00< 0.001 – 0.27< 0.001– 0.00760.92– 0.0790.330.64< 0.001impact of smoking on health Attitude to own role in30.09< 0.0010.36< 0.001 – 0.080< 0.050.00800.83– 0.0240.530.26< 0.001smoking cessation counseling Self-perceived70.51< 0.0010.42< 0.001 – 0.0510.100.00250.94– 0.0140.660.36< 0.001competency in smoking cessation counseling AHRQ strategies Ask8.01< 0.001 0.19 < 0.01 0.0970.19– 0.0450.540.23< 0.01Advice6.29< 0.001 0.049 0.43 0.0290.66– 0.0440.510.0340.60Assist11.41< 0.001 0.087 < 0.05 0.0300.510.0530.250.17< 0.001Arrange7.77< 0.001 0.12 0.065 0.0300.650.0810.230.23< 0.001
Table 4—Multilevel Modeling on the Effect of Individual Level Covariables on Knowledge, Attitude, Self-Perceived Competence, and Practice of AHRQ Strategies
| Variables | Knowledge of the Impact of Smoking on Health | Attitude to Own Role in Smoking Cessation Counseling | Self-Perceived Competency in Smoking Cessation Counseling | AHRQ Strategies | |||
| Ask | Advice | Assist | Arrange | ||||
| Gender | 1.53/0.22 | 0.16/0.69 | 3.15/0.08 | 0.79/0.37 | 2.14/0.15 | 2.58/0.11 | 0.17/0.68 |
| Age | 1.13/0.34 | 0.42/0.74 | 3.90/< 0.05 | 1.42/0.24 | 1.38/0.25 | 0.67/0.57 | 0.18/0.91 |
| Professional registration | 0.07/0.80 | 0.01/0.94 | 0.16/0.69 | 0.85/0.70 | 0.00/0.95 | 0.08/0.78 | 0.01/0.93 |
| Postgraduate education | 0.22/0.64 | 0.02/0.90 | 0.05/0.83 | 0.15/0.36 | 0.32/0.57 | 0.45/0.50 | 0.07/0.80 |
| Staff grade | 0.49/0.61 | 1.83/0.16 | 1.29/0.28 | 3.89/< 0.05 | 4.35/<0.05 | 3.21/< 0.05 | 3.77/< 0.05 |
| Service settings | 1.24/0.27 | 0.23/0.63 | 0.93/0.34 | 6.88/< 0.01 | 2.10/0.15 | 3.87/0.05 | 3.25/0.07 |
Category: Smoking
Tags: evaluation, Smoking Cessation, social workers, training