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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 1  |  Page : 81-86

Knowledge, preparedness and percieved barriers among clinicians and academicians regarding tobacco cessation counseling in Bhopal City


Department of Public Health Dentistry, Peoples Dental Academy, Bhopal, Madhya Pradesh, India

Date of Submission26-Feb-2020
Date of Acceptance08-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Swati Agrawal
Department of Public Health Dentistry, Peoples Dental Academy, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_35_20

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  Abstract 


Background: Tobacco use is responsible for 3 million deaths globally every year. Tailored counseling by a specialist increases quit rates additionally by 4%–7% compared to normal. Now, tobacco cessation is a part of oral health assessment. Hence, brief advice from dental health professionals as part of their routine consultations or interactions is an approach that makes use of existing health-care systems. Purpose: A study was carried out among the dental professionals of Bhopal to assess their knowledge, preparedness, and perceived barriers regarding tobacco cessation counseling. Materials and Methods: A cross-sectional questionnaire study was conducted among dental professionals which include academicians (Group 1), clinicians (Group 2), and both clinicians and academicians (Group 3) of Bhopal City over a period of 3 month's from May to July 2019. Two-hundred dental professionals were approached, in which 145 participated in the study. Self-administered structured, semi-open, and coded questionnaire was mailed to them and analysis was done. Results: The findings of the study suggest that almost all the groups agreed that they have a role in helping patients regarding tobacco cessation. Our study has overcome all the perceived barriers as 75.9% of Group 3 professionals got positive feedback from the patients after counseling and 70.9% of academicians feel chances of quitting tobacco have increased after they advised the patient to quit the habit, but 42.9% of Group 3 professionals think that they don't get time to counsel patients. Conclusion: As concluded in our study, Group 3 dental professionals (both academicians and clinicians) have better knowledge and actively participate in cessation of patients as compared to academicians and clinicians. Hence, there is an urgent need to sensitize and train clinicians and academicians at community and institutional levels.

Keywords: Academicians, clinicians, dental professionals, knowledge, tobacco cessation


How to cite this article:
Jain S, Agrawal S, Sharva V, Lohiya J. Knowledge, preparedness and percieved barriers among clinicians and academicians regarding tobacco cessation counseling in Bhopal City. J Indian Assoc Public Health Dent 2021;19:81-6

How to cite this URL:
Jain S, Agrawal S, Sharva V, Lohiya J. Knowledge, preparedness and percieved barriers among clinicians and academicians regarding tobacco cessation counseling in Bhopal City. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Apr 17];19:81-6. Available from: https://www.jiaphd.org/text.asp?2021/19/1/81/312642




  Introduction Top


Tobacco use is responsible for 3 million deaths globally every year. There are 1.1 billion adult smokers and at least 367 million smokeless tobacco (SLT) users globally. In southeast Asia, approximately 1.2 million people die every year from tobacco use. By 2030, if urgent action is not taken, the death count will rise to more than 8 million. Tobacco is the only legally available consumer product which kills people when it is used entirely as intended.[1]

India is the second-largest consumer of tobacco products, with more than 200 million users of smokeless forms of tobacco SLT and 276 million consumers of tobacco overall. Situation in India is worse because of predominant tobacco users, which covers both socioeconomic and ethnic groups and it is feast over metropolitan areas as well as remote villages. According to the survey of global adult tobacco survey 2 2016–17 in India, 42.4% of men, 14.2% of women, and 28.6% (266.8 million) of adults currently use tobacco. In Madhya Pradesh, 38% of population smoke tobacco daily and 39% use SLT which leads to a rise in oral cancer.[2],[3]

Tobacco control is a preventable cause of mortality and morbidity. It is imperative to provide tobacco cessation services to tobacco users behaviour modification and awareness regarding tobacco hazards and its consequences is a necessary step to redice risks. Tailored counseling by a specialist increases quit rates additionally by 4%–7% compared to normal. Ain et al. suggested that 67.07% of the dentists agreed that it is their role in helping patients to quit smoking, but 77% of dentists do not have time to do tobacco cessation.[4] Amit et al. in 2011 concluded that there is a need of effective planning for execution of tobacco cessation by authorities at regular intervals to achieve a goal of “tobacco free society.”[5]

Tobacco cessation: Dentist's role

Currently, only 30% of the world's population have access to appropriate tobacco cessation services. Without cessation assistance, only 4% of attempts to quit tobacco succeed. Proven cessation medications and professional support can double a tobacco user's chance of successfully quitting. Now, tobacco cessation is a part of oral health assessment. Hence, brief advice from dental health professionals as part of their routine consultations or interactions is an approach that makes use of existing health-care systems. When a tobacco user visits a primary or specialized care service, it presents an opportunity for the dentists to offer and provide them with personalized counseling. Brief advice is a key means of motivating people who might not otherwise seek tobacco cessation support and encouraging them to quit, and as such is an essential component of tobacco cessation services.[1]

Hence, the present study was carried out among the dentists of Bhopal to assess their knowledge preparedness and perceived barriers regarding tobacco cessation counseling.


  Materials and Methods Top


A cross-sectional questionnaire study was conducted among dental professionals which include clinicians, academicians, and both of Bhopal City over a period of 3 months from May to July 2019. A convenience sampling technique was employed.

All the dental professionals who were willing to participate in the study were included. Those who are not willing and not available during the study period were excluded.

Estimation of sample size was done by using Epi Info software, hypothesis percentage frequency outcome factor in the population was taken with 95% confidence interval and estimated sample size obtained was ± 280, of which 200 dental professionals were approached, in which 145 participated in the study. Self-administered structured, semi-open, and coded questionnaire was formulated by the experts. Face validity and content validity of the questionnaire were evaluated by team of experts which includes public health dentists. Reliability of questionnaire was evaluated by doing a pilot study among 10 dentists and test–retest reliability coefficient obtained was r > 0.70 and Cronbach's alpha was found to be satisfactory. The 145 dentists to whom the questionnaire was sent included the private practitioners, the dentists working in the dental colleges, and those who are both academicians and clinicians.

The survey of the present study included questions that inscribe (a) demographic details which include name, age, gender, and educational qualification, (b) knowledge regarding tobacco cessation, (c) preparedness and steps taken for tobacco cessation, (c) barriers in tobacco cessation, and (d) patients counseled and their success rate. This is in compliance with the methodology used by Ain et al. in their study. The questionnaire was hand-delivered as well as mailed to the dental professionals and collected after 2 days.

Ethical clearance was obtained from the Institutional Ethics Committee of Peoples Dental Academy, Bhopal (IEC No-2019/300/10). Data collected were entered into Microsoft Excel. Descriptive statistics and inferential statistics were calculated for qualitative data using Statistical Package for Social Sciences(SPSS) 20.0. Chi-square test was applied to test the association between comparison groups and P < 0.05 was considered statistically significant.


  Results Top


Out of 200 dental professionals to whom questionnaire was mailed, 145 responded in a week's time with a response rate of 72.5%. The demographic details of the dental professionals are mentioned in [Table 1].
Table 1: Demographic characteristics of the study participants (n=145)

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The findings of the study suggest that almost all the groups agreed that they have a role in helping patients regarding tobacco cessation. Hundred percent academicians agreed that tobacco cessation counseling should be a part of curriculum. Majority of Group 1 (54.1%) and Group 2 (50%) professionals think that they lack knowledge regarding tobacco cessation counseling as compared to Group 2 (37.2%) professionals. Ninety-three percent clinicians were familiar with types, constituents, and effects of tobacco consumption as compared to academicians (83.3%) and both (87%). However, no statistically significant difference was observed between groups related to knowledge [Table 2] and [Figure 1]. Preparedness among dental professionals regarding steps taken for tobacco cessation shows that 48.5% of academicians have taken training regarding tobacco cessation as compared to clinicians (32.5%) and both (27.7%) which is very low, 7.4% of both clinicians and academicians (Group 3) advise nicotine replacement therapy (NRT). About 85.3% of Group 3 dentists only prescribe nicotine substitutes to patients who want to quit as compared to Group 1 (79.1%) and Group 2 (55.8%). As compared to Group 2 dental professionals (27.9%), both Group 1 (50%) and Group 3 (51.8%) professionals refer their patients to a psychiatrist for counseling and P value obtained was statistically significant. A statistically significant difference (P = 0.03) was observed between the groups regarding the check on patients' follow-up visits who are enrolled for cessation [Table 3] and [Figure 2].
Table 2: Dental professionals knowledge regarding tobacco cessation

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Figure 1: Dental professionals knowledge regarding tobacco cessation

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Table 3: Dental professionals preparedness regarding tobacco cessation

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Figure 2: Dental professionals preparedness regarding tobacco cessation

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In previous studies, the most common barriers for successful tobacco cessation are Dentists-patient relation, routine stress on habit history and time to counsel patients. About 22.2% of Group 3 professionals are of the opinion that if they ask patients regarding tobacco, it might affect dentist–patient relationship as well patient might not turn up again. About 79.1% of academicians feel that chances of quitting increased after they advised their patients to quit, 75.9% Group 3 professionals got positive feedback from their patients after counseling, and 32.5% of clinicians are of the opinion that they do not get time to counsel their patients. As compared to Group 1 and Group 3 professionals, 25.5% of clinicians consume tobacco, which was statistically significant [Table 4] and [Figure 3].
Table 4: Perceived barriers regarding tobacco cessation among dental professionals

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Figure 3: Perceived barriers regarding tobacco cessation among dental professionals

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  Discussion Top


In the current study, 100% of academicians, 99% of clinicians, and 98% of Group 3 think that they have a role in helping patients in tobacco cessation. This is in close agreement with the study of Ain et al.[4] and others,[6],[7] in which 67.07% of dentists agreed that they have a role in helping patients in tobacco cessation. Only 50% of academicians and clinicians think they have lack of knowledge about tobacco cessation counseling, but this was not in accordance with the study where majority think they have a lack of knowledge.[4] Majority of clinicians know about 5A's of tobacco cessation counseling and 100% of academicians think that tobacco curriculum should be a part of curriculum. The study reveals that dentists have knowledge about aspects of tobacco cessation, but there is a need of proper training to implement it successfully.

According to the study conducted by Ibrahim and Norkhafizah.,[8] majority of dental practitioners have a role in smoking cessation counseling, but there was a lack of training in their practices; similarly, a study was conducted by Vinod et al.[9] to evaluate the role of oral physicians as a counselor in tobacco cessation, in which only 5.4% of dental practitioners had taken additional training pertaining to tobacco cessation, as in the present study, 32.5% of clinicians, 45.8% of academicians, and 27.7% of Group 3 dental professionals have taken additional training and 76.8% of clinicians, 75.9% of Group 3, and 70.8% of academicians are willing to undergo tobacco cessation training which is accordance with the previous study.[4] In the current study, 74.4% of clinicians, 70.8% of academicians, and 55.5% of Group 3 dentists positively replied about counseling the patients about habit cessation, thus fulfilling their moral and professional obligations and playing an important role in tobacco cessation which is in accordance with the previous study.[9] In the present study, all the three groups were compared for the steps taken for tobacco cessation, highest positive response among clinicians was for warning(30.2%), 75% of academicians were advising the patient about tobacco cessation, 7.4% of Group 3 professionals were using NRTs, and 11.1% of Group 3 professionals were using other pharmacological agents and behavioral therapies as seen in the previous study,[9] suggesting that there is a need of more work to be done in the field of educating and counseling patients for habit cessation.[10]

Dental professionals are the first to recognize any changes in the oral cavity. In the current study, 79.1% of academicians, 77.7% of Group 3, and 74.4% of clinicians advised their patients for routine screening of oral cancer as mortality and morbidity of oral cancer can be significantly reduced if detected in early stages. In our study, 27.9% of clinicians thought of sending patients to psychiatrist for counseling as compared to both the groups and the value is statistically significant (P < 0.05) which was found evident with the previous study[9] and 79.1% of academicians counsel and speak to patients family members, relatives, and friends for their support to help the patient in quitting as tobacco cessation is a multidisciplinary approach. To increase the quit rate among patients, a constant check on follow-up is needed, as in our study, 85.4% of academicians, 79.6% Group 3, and 60.4% of clinicians were monitoring their patients' follow-up, which was statistically significant, thus implying that there is a need of inclusion of other protocols like phone calls, messages, WhatsApp messages, and e-mails for the same.

The most common barriers perceived by the dental professionals in the previous studies[11],[12] were lack of resources, lack of training, and dentists' fear that the patients may not turn up again. Our study has overcome some of the perceived barriers as 75.9% of Group 3 professionals got positive feedback from the patients after counseling, 70.9% of academicians feel chances of quitting tobacco have increased after they advised the patient to quit the habit,[13] but 8.3% of academicians think that patients may not turn up, 25.5% of clinicians use tobacco[14],[15] which was found statistically significant as compared to other groups, and 42.9% of Group 3 professionals think that they do not get time to counsel patients which is in accordance with the previous study.[12],[16],[17]

Hence, it is suggested that tobacco cessation training should be provided in each institution/university and tobacco curriculum should be a part undergraduate curriculum so that dental professionals would be able to decrease the rate of tobacco usage and curb the menace of oral cancer, as Singla et al.[18] concluded that dental professionals must expand their horizons and armamentarium to include tobacco cessation counseling strategies inclusive of their regular preventive and therapeutic treatment modalities.

Limitation of the study

The results of the study cannot be generalized as the study is limited to dentists from Bhopal City and further research is required in this field.


  Conclusion Top


As concluded in our study, Group 3 dental professionals (both academicians and clinicians) have better knowledge and actively participate in cessation of patients as compared to academicians and clinicians. Hence, there is an urgent need to sensitize and train clinicians and academicians at community and institutional levels. For academicians, tobacco cessation modules/CDE programs/workshops should be conducted by respective institutions/universities to enhance their knowledge and improve cessation skills so they can overcome the barriers faced during cessation counseling. At the clinical level, it should be made mandatory by the government that private practitioners should have done a certificate course on tobacco cessation and a tobacco cessation cell and counselor should be there in each and every clinic and hospital. This will help in solving patients' problems and prevention of diseases like oral cancer will certainly increase their practice and income.

In the present study limited stress was given on lost to follow up, behavioural and pharamcological therapies. Thus, the need of an hour is to maintian a constant communication with the patients through phonecalls, E-mails and whatsApp messages.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO Report on the Global Tobacco Epidemic, Offer Help to Quit Tobacco Use 2019: The MPOWER package. Geneva: World Health Organization; 2019.  Back to cited text no. 1
    
2.
Centre of Disease Control. Tobacco Use: Targeting the Nation's Leading Killer. Accessed from: Tobacco Use: Targeting the Nation's Leading Killerwww.cdc.gov/chronicdisease/resources/.../tobacco_ aag_2011_508.pdf. [Last accessed on 20 Jan 2020].  Back to cited text no. 2
    
3.
Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; November, 2005. Accessed from: Manual for Tobacco Cessation - IARC Screening Groupscreening.iarc.fr/doc/Cancer_resource_Manual_4_Tobac co_New.pd. [Last accessed on 20 Jan 2020].  Back to cited text no. 3
    
4.
Ain TS, Sultan S, Gowhar O, Ravishankar TL. Tobacco cessation counseling among dental professionals – Willingness, knowledge and perceived barriers. Int J Contemp Med Res 2016;3:2990-3.  Back to cited text no. 4
    
5.
Amit S, Bhambal A, Saxena V, Basha S, Saxena S, Vanka A. Tobacco cessation and counseling: A dentists' perspective in Bhopal city, Madhya Pradesh. Indian J Dent Res 2011;22:400-3.  Back to cited text no. 5
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Bhat N, Jyothirmai-Reddy J, Gohil M, Khatri M, Ladha M, Sharma M. Attitudes, practices and perceived barriers in smoking cessation among dentists of Udaipur City, Rajasthan, India. Addict Health 2014;6:73-80.  Back to cited text no. 6
    
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Logan H, Levy S, Ferguson K, Pomrehn P, Muldoon J. Tobacco-related attitudes and counseling practices of Iowa dentists. Clin Prev Dent 1992;14:19-22.  Back to cited text no. 7
    
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Ibrahim H, Norkhafizah S. Attitudes and practices in smoking cessation counselling among dentists in Kelantan. Arch Orofac Sci 2008;3:11-6.  Back to cited text no. 8
    
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Vinod VC, Taneja L, Mehta P, Koduri S. Dental professionals as a counsellor for tobacco cessation: A survey. J Indian Acad Oral Med Radiol 2017;29:209-12.  Back to cited text no. 9
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Raja A, Aukett J. Smoking cessation and the dental team. Dent Update 2006;33:175-6, 179-80, 183-4.  Back to cited text no. 11
    
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Johnson NW, Lowe JC, Warnakulasuriya KA. Tobacco cessation activities of UK dentists in primary care: Signs of improvement. Br Dent J 2006;200:85-9.  Back to cited text no. 12
    
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Shalihin MS, Mohamed MH. Knowledge, attitude and practice scale of medical personnel on smoking cessation guidelines: A review on associations and questionnaires. Borneo J Med Sci 2019;3:3-13.  Back to cited text no. 13
    
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Ayyad HA, Farag MR, Elzahaf RA. Knowledge, attitudes and reported practices dental students in Omer Almokhtar University regarding tobacco effects on oral cavity health. World J Curr Med Pharm Res 2020;11:4-10.  Back to cited text no. 14
    
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Saddichha S, Rekha DP, Patil BK, Murthy P, Benegal V, Isaac MK. Knowledge, attitude and practices of Indian dental surgeons towards tobacco control: Advances towards prevention. Asian Pac J Cancer Prev 2010;11:939-42.  Back to cited text no. 15
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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