Preparedness of frontline health workers for tobacco cessation: An exploratory study from two states of India.
BACKGROUND
The 5As approach is a clinic-based approach and has been developed for primary health care providers who are uniquely positioned to interact with tobacco users. The 5As stands for: Ask about tobacco use at every visit, advise tobacco users to quit, assess readiness to quit, assist quit attempts through counseling and pharmacotherapy and arrange follow-up to prevent relapse. The present study explores whether auxiliary nurse midwives (ANMs) adhere to the 3As from the recommended 5As model for tobacco cessation.


METHODS
The study was a cross-sectional study conducted among 501 ANMs in the state of Gujarat and Andhra Pradesh. Descriptive analysis and chi-square test were employed to test the differences in knowledge levels and practices of ANMs. Bivariate logistic regression was used to examine the association between each predictor variable separately and the outcome variables after adjusting for age and location. Data was analyzed using SPSS version 17 software.


RESULTS
Majority of ANMs reported that they were aware of respiratory illnesses, tuberculosis, lung and oral cancer as conditions caused due to tobacco consumption. Awareness of adverse reproductive and child health effects associated with tobacco use was very low. Only about one third of respondents informed all patients about harmful effects. Only 16% of ANMs reported having ever received any on-job training related to tobacco control. ANMs who reported receiving training in tobacco control were about two times more likely to provide information on health effects of tobacco as compared to those who reported not being trained in tobacco control in the state of Gujarat.


CONCLUSIONS
A majority of ANMs ask patients about tobacco use but provide advice only to patients suffering from specific diseases. A context-specific capacity building package needs to be designed to equip ANMs in recommended 5As approach in tobacco cessation.
Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India.
Rajmohan
R
Panda
Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India.
Swati
S
Srivastava
Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India.
Divya
D
Persai
Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India.
Manu Raj
MR
Mathur
Department of Preventive and Social Medicine, Government Medical College, Gujarat, India.
Bhavesh
B
Modi
Department of Health and Family Welfare, Government of Gujarat, Gujarat, India.
Paresh
P
Dave
Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India.
Monika
M
Arora
India; nurse midwives; tobacco control