Date Available

4-20-2022

Year of Publication

2022

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Evelyn Parrish

Clinical Mentor

Dr. Chizimuzo Okoli

Committee Member

Dr. Karen Butler

Abstract

Background: Tobacco use is the leading preventable cause of death and disease in the United States, with the prevalence remaining especially high among people with mental illness. Mental health providers often lack training in smoking cessation and feel uncomfortable addressing the issue with this patient population. Studies show that educational training offered to providers can lead to increased knowledge that improves the provider’s confidence and attitude about delivering smoking cessation treatment to patients. Mental health professionals must receive training on smoking cessation treatment modalities so they can effectively provide holistic care needed for recovery for patients with mental illness.

Purpose: The purpose of this DNP project was two-pronged. The first step evaluated the effectiveness of a web-based simulated smoking-cessation scenario training for mental health professionals to evaluate if this intervention would promote providers’ intentions to adhere to the U.S. Preventative Services Task Force (2021) Tobacco Treatment Practice Guideline. The second step assessed face validity of the video intervention.

Design: A one group pretest-posttest design was conducted at an acute psychiatric hospital to evaluate the web-based simulated scenario training.

Methods: The web-based simulated scenario had 3 components: 1) A presurvey to assess knowledge, attitudes, subjective norms, perceived behavioral control and intentions toward implementing smoking cessation interventions for patients with mental illnesses 2) A 20-minute video with education on tobacco use and mental illness and a simulated patient-provider scenario, and 3) A postsurvey to reassess knowledge, and intentions toward implementing smoking cessation interventions for patients with mental illnesses. In addition, an assessment of the videos within the training program by field experts was completed to analyze desirability, applicability, and acceptability.

Results: In the first prong, eighteen participants enrolled and completed the schizophrenia scenario training (N= 18). Low participation rate in the ADHD scenario led to analysis focused solely on the schizophrenia scenario. Analysis was conducted on knowledge scores and intentions to utilize the 5A’s. Knowledge scores significantly improved post-intervention from a score of 3.0 (0.9) to 4.3 (1.2) with a p-value of 0.005. Intentions to use the 5A’s post-intervention was high with a score of 11 (2.5). In the second prong, two experts assessed the ADHD scenario and two assessed the schizophrenia scenario. For the ADHD video, experts scored desirability, applicability, and acceptability as most desirable (5). For the schizophrenia scenario, desirability was 5 for information about tobacco use and schizophrenia and for all 5As, but 4 for overall use of the information. Applicability was scored 5 for Ask and Assist and 4.5 for Advise, Assess, Arrange, overall use of animation, and information about tobacco use and schizophrenia. Acceptability was scored 5 for Assist, 4.5 for information about tobacco use and schizophrenia, Ask, Advise, Assess, and Arrange, and 4 for overall use of animation.

Discussion: In the first prong, presurvey showed a knowledge deficit. Attitudes and intentions scores were neutral while perceived behavioral control and subjective norms were lower. Postsurvey showed MHPs gained knowledge and had high intentions to use the 5As suggesting the intervention may have increased knowledge and intentions to provide treatment based on USPSTF (2021) guidelines. In the second prong, the ADHD scenario proved to be rated highest on each category, appearing to have high face validity. In the future, the schizophrenia scenario may improve with adjustments in animation and language.

Conclusion: Web-based simulated training improved MHPs’ knowledge and intentions of providing smoking cessation interventions to patients with mental illness. As MHPs gain knowledge through training programs, dissemination of this knowledge into clinical practice will enhance the overall mental and physical well-being of patients with mental illness.

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