Is an online computer-tailoring program for practice nurses effective in improving their smoking cessation counseling?

Abstract

Background Practice nurses make sub-optimal use of evidence-based smoking cessation counseling protocols in Dutch general practice. We developed an online computer-tailored program to improve practice nurses' protocol adherence. Aim of this study was to evaluate the program's effectiveness in a randomized trial. Methods Practice nurses were randomized to either have full access to the online computer-tailored program (intervention group, N=147), or mere access to general project information (control group, N=122) for six months. Practice nurse demographics, socio-cognitive determinants and protocol adherence were assessed at baseline and after six months. Practice nurses also completed counseling checklists after every smoking cessation consultation during the study period. Counseled smokers reported on smoking status and the cessation care content they received at baseline and after six months. Data from counseling checklists and smoker questionnaires were combined to calculate practice nurses' protocol adherence. Findings Data from 216 practice nurses and 396 smokers was available. After six months, the computer-tailored program showed a small effect on overall protocol adherence and assessing and improving smoker motivation (ES 0.18-0.22), indicating improved smoking cessation counseling among practice nurses exposed to the program. Furthermore, a trend towards higher protocol adherence among more frequent program users was found. Discussion The online computer-tailored program showed positive but small effects on smoking counseling protocol adherence. As program use was limited during the trial period and more frequent use was associated with improved adherence, we now need to focus on both improving the program content and stimulating more frequent program application by its users.