Smoking among pregnant women poses risks to the baby;yet, up to one-third of women continue to smoke during pregnancy. Obstetric providers are charged to help women quit. Most providers, however, have not learned the most effective counseling methods. Programs to teach OB providers must be easy for busy providers to use and effective without much of a time commitment from providers. In this application, we propose to develop medical technology to improve smoking cessation counseling skills among obstetric care providers. Fortunately, effective, evidence-based provider counseling strategies, such as the 5 A's-Ask, Advise, Assess, Assist and Arrange exist. Yet, ineffective methods of teaching the 5 A's exist, namely through written guidelines or didactic presentations. Even though providers might have received these other educational resources, most obstetric care providers only Ask and Advise, two of the least critical elements of the 5 A's. When taught with effective methods, providers can learn specific communication skills50-59 that subsequently lead to improved health outcomes.50, 59, 60 The proposed intervention uses an internet-based, interactive training program that incorporates examples of providers'own smoking cessation counseling communication from actual audio-recorded obstetric visits. The design of this intervention addresses several factors that are keys for a successful training intervention with practicing OB providers.62, 63 First, practicing clinicians need programs they can incorporate into their busy schedules.64-66 This training should be brief, easy to access, and not interfere with their practice. Second, the intervention needs to be theory-based and consistent with educational principles. Interactive continuing medical education is rated as the one of the best methods for teaching new skills and clinical practices69, 79, 80 and has been shown to increase learner retention and satisfaction.81 Finally, the training needs to be relevant to the provider.62 63, 65, 67 Personally relevant information is more attended to, processed more carefully, and retained longer. Providers also need feedback on the communication and cannot learn just from being told which skills to use. Providers tend to inaccurately assess their level of competence with skills, and only with feedback, are they able to improve. We have already collected audio recordings of actual encounters from obstetric providers. We also have created two similar interventions, one for primary care physicians addressing weight and the other for oncologists addressing negative emotion. Thus, we are building on our current work. To develop this intervention, we will use our audio-recorded first obstetric visits between obstetrics providers and their pregnant patients who smoke. We will adapt our primary care intervention that addressed weight to address prenatal smoking. We will then pilot test this intervention among obstetric provides and assess usability, acceptability, satisfaction, and potential impact. Once successful with our Phase I aims, we will apply for Phase II funding to test the efficacy of this intervention.
This study will develop an interactive, web-based, theory-based program will improve obstetric care providers'smoking cessation counseling skills with their pregnant patients who smoke. The intervention will include tailored clips from audio recordings of actual patient-provider discussions. We will also assess the program for acceptability and usability.
