QUITADVISOROB: FEASIBILITY AND ACCEPTABILITY OF AN EVIDENCE-BASED DECISION TOOL FOR TOBACCO CESSATION IN THE OBSTETRIC/GYNECOLOGIC SETTING

Purpose: Over 25% of pregnant women in Kentucky smoke cigarettes compared to 12% nationally. Smoking during pregnancy increases risks for both mother and child during and following pregnancy, but tobacco cessation can reduce or eliminate these adverse outcomes. This study examined the feasibility and acceptability of a web-based, point-of-care decision support tool (QuitAdvisorOB) designed for use by health care providers. This interactive, targeted and tailored tool was developed using an algorithm based on the 5A’s (Ask, Advise, Assess, Assist, Arrange), stages of change, and principles of motivational interviewing to facilitate the delivery of brief, patient-tailored tobacco treatment counseling in the obstetric/gynecologic (OB/GYN) setting.  

Method: Fourteen participants (11 OB/GYN physicians and 3 nurse practitioners; 86% female; years in practice M=6.00±10.41) were recruited from clinics associated with the University of Kentucky. Six participants did not complete follow-up, reducing the final sample to seven physicians and one nurse practitioner. Providers completed a baseline survey (PRE), received QuitAdvisorOB training, and then used the tool for two months. They then completed a follow-up questionnaire (POST) and interview regarding their experience using QuitAdvisorOB. PRE and POST surveys assessed knowledge, attitudes, and practices regarding tobacco use and tobacco cessation counseling. The POST survey also assessed perceived usability and satisfaction with the QuitAdvisorOB tool.

Result: PRE-POST comparisons indicated significant increases in the delivery of tobacco treatment interventions, particularly the frequency with which providers assisted with quit attempts (t(7)=2.50, p<.041) and arranged follow-up (t(7)=4.78, p<.002). Participants also reported increased self-efficacy to implement evidence-based interventions (t(7)=2.50, p<.041), increased overall level of comfort working with tobacco users (t(7)=4.14, p<.004), and improvements in comfort (t(7)=2.93, p<.022) and frequency in assisting patients with developing a personalized tobacco cessation plan (t(7)=2.55, p<.038). Notably, 75% of participants indicated that they were interested in continuing to use the QuitAdvisorOB tool and would recommend it to a colleague.

Conclusion: Despite the small sample, this feasibility and acceptability trial revealed behavior changes regarding implementation of evidence-based tobacco treatment interventions in the OB/GYN setting, and the results exceeded a priori feasibility and acceptability criteria.