title: Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster-randomized community trial.
abstract: OBJECTIVE
  Tobacco use adversely affects oral health. Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented successfully. This study aimed to evaluate two interventions to enhance tobacco use prevention and cessation (TUPAC) counselling among oral health professionals in Finland.
  
  
  METHODS
  We used a cluster-randomized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists (n=73) and dental hygienists (n=22) in Finland. Educational intervention consisted of 1 day of training, including lectures, interactive sessions, multimedia demonstrations and a role play session with standard patient cases. Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling. TUPAC counselling procedures provided were reported and measured using an electronic dental records system. In data analysis, intent-to-treat principles were followed at both individual and cluster levels. Descriptive analysis included chi-square and t-tests. A general linear model for repeated measures was used to compare the outcome measures by intervention group.
  
  
  RESULTS
  Of 95 providers, 73 participated (76.8%). In preventive counselling, there was no statistically significant time effect or group-by-time interaction. In cessation counselling, statistically significant group-by-time interaction was found after a 6-month follow-up (F=2.31; P=0.007), indicating that counselling activity increased significantly in intervention groups. On average, dental hygienists showed greater activity in tobacco prevention (F=12.13; P=0.001) and cessation counselling (F=30.19; P<0.001) than did dentists. In addition, cessation counselling showed a statistically significant provider-by-group-by-time interaction (F=5.95; P<0.001), indicating that interventions to enhance cessation counselling were more effective among dental hygienists.
  
  
  CONCLUSIONS
  Educational intervention yielded positive short-term effects on cessation counselling, but not on preventive counselling. Adding a fee-for-service to education failed to significantly improve TUPAC counselling performance. Other approaches than monetary incentives may be needed to enhance the effectiveness of educational intervention. Further studies with focus on how to achieve long-term changes in TUPAC counselling activity among oral health professionals are needed.
authors.affiliation: Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland. masamitsu.amemori@helsinki.fi
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Amemori
authors.forename: Jorma
authors.initials: J
authors.lastname: Virtanen
authors.forename: Tellervo
authors.initials: T
authors.lastname: Korhonen
authors.forename: Taru H
authors.initials: TH
authors.lastname: Kinnunen
authors.forename: Heikki
authors.initials: H
authors.lastname: Murtomaa
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002983:Clinical Competence; D003376:Counseling / Q000193:education*; D003756:Dental Hygienists / Q000191:economics / Q000193:education*; D003815:Dentists / Q000191:economics; D004498:Education, Dental, Continuing; D057286:Electronic Health Records; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D019212:Multimedia; D017063:Outcome Assessment, Health Care; D012052:Reimbursement, Incentive; D012381:Role Playing; D020377:Self Efficacy; D000074606:Smoking Prevention; D013663:Teaching / Q000379:methods; D013997:Time Factors; D020340:Tobacco Use Cessation / Q000706:statistics & numerical data