title: Does receipt of 5As services have implications for patients' satisfaction in India?
abstract: BACKGROUND
  The 5As model for behavior change counseling is an evidence-based counseling approach. This study aims to explore the relationship between patient satisfaction with counseling services and 5As interventions in tobacco cessation. We also investigated the impact of satisfaction with counseling services on patients' intention to quit and recommendation of those services to other tobacco users.
  
  
  METHODS
  Two cross-sectional surveys were administered among patients and physicians working in primary health care facilities in 12 districts of two states in India. Health facilities and patients were recruited by systematic random and simple random sampling respectively. We limited our analyses to only those patients who were asked about their tobacco consumption. We used multivariable logistic regression to investigate associations between individual components of 5As interventions and patients' satisfaction with the counseling services.
  
  
  RESULTS
  Patients who reported that they were 'advised' to quit (OR: 9.56; 95% CI: 1.89-48.28), 'assessed' for readiness to quit (OR 2.1, 95% CI: 1.07-4.15) and offered cessation 'assistance' (OR 2.2, 95% CI: 1.17-4.29) were more satisfied with the counseling services. Patients who were satisfied with the counseling services were five times more likely to have an intention to quit tobacco (OR: 5.45, 95% CI: 3.59 to 8.27) and four times as likely to recommend counseling to other tobacco users (OR 3.83; 95% CI:2.46 -5.96).
  
  
  CONCLUSIONS
  Incorporating 5As interventions in the delivery of primary care would likely increase patients' satisfaction with physicians' delivered counseling services. Patients' recommendation of counseling services will aid in demand generation for cessation services in primary care.
authors.affiliation: Public Health Foundation of India, New Delhi, India. divya.persai@phfi.org.
authors.forename: Divya
authors.initials: D
authors.lastname: Persai
authors.affiliation: Public Health Foundation of India, New Delhi, India. raj.panda@phfi.org.
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Panda
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK. Sudhir.Venkatesan@nottingham.ac.uk.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Venkatesan
authors.affiliation: Public Health Foundation of India, New Delhi, India. monika.arora@phfi.org.
authors.forename: Monika
authors.initials: M
authors.lastname: Arora
authors.affiliation: Center for Health Equity, University of Minnesota, Minneapolis, MN, USA. jahluwal@umn.edu.
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India; D033182:Intention; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D020340:Tobacco Use Cessation / Q000379:methods / Q000523:psychology; D014029:Tobacco Use Disorder / Q000628:therapy*