Research code: 4378-94
Ethics code: IR.ABZUMS.REC. 1400.169
Clinical trials code: None.
, m.mohammadi@abzums.ac.ir
Abstract: (60 Views)
Background: Smoking is a leading cause of mortality worldwide (1). It is a risk factor for many types of pulmonary, cardiovascular, and malignant disorders, and its cessation can significantly reduce the risk of premature death. Smoking also imposes considerable health costs on individuals and the health system (3). In a study by Abbasi-Kangevari and colleagues in Iran, the overall prevalence of smoking was estimated at 9.33% (4).
Helping people with nicotine addiction is the main purpose of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to protect the population from the devastating health effects of tobacco consumption (7).
Pharmacists, as one of the most accessible healthcare providers, are well positioned to provide smoking cessation counseling. Smokers with underlying chronic medical conditions frequently visit pharmacies for medication. In this situation, pharmacists have a special opportunity to encourage, motivate, conduct behavioral therapy, and recommend the use of non-prescription medicinal items to quit smoking (8).
Considering the high frequency of smoking in Iran and the capacity of community pharmacies to support smoking cessation, this study was conducted to evaluate the knowledge, attitudes, and practice of Iranian pharmacists regarding smoking cessation services.
Methods: The current research was a cross-sectional study of Iranian pharmacists between 2021 and 2022. The Research Ethics Committee of Alborz University of Medical Sciences approved the study (IR.ABZUMS.REC. 1400.169).
A questionnaire was prepared based on a previous study (10), and then it was translated into Persian using the forward-backward translation method adapted from the Beaton et al. study (11). The validity of the questionnaire was confirmed with a content validity ratio (CVR) of 0.9 and a content validity index (CVI) of 0.88. The questionnaire reliability was confirmed by calculating Cronbach’s alpha = 0.94. The final version of the questionnaire contained six parts: demographic information, questions on knowledge, attitude, practice, educational history/self-confidence, and existing obstacles. The questionnaire was uploaded to the Epoll online platform, and its link was provided to the pharmacists through the provincial virtual networks of the Iranian Pharmacists Association.
The “knowledge” part of the questionnaire included 15 questions on interventions and prescription and OTC drugs used for smoking cessation. To evaluate the participants’ knowledge level, a score of 11 or higher was considered a “good” level, a score of 6-10 was an “average” level, and a score of 5 or less was a “weak” level of knowledge.
The attitude section included two statements on positive attitudes, three statements on negative attitudes, and one statement on economic attitudes. The participants were asked to express their opinion as “agree”, “disagree”, or “no opinion”. A score of +1 was considered for agreeing with positive statements or disagreeing with negative ones, a score of -1 for the opposite condition, and a score of 0 in the case of “no opinion”. The range of points that could be obtained in this part was between -5 and +5.
Data analysis was conducted using IBM SPSS Statistics for Windows, Version 16. The chi-square test was used to assess the relationship between knowledge and the study variables. The relationship between attitudes and study variables was investigated using the Mann–Whitney test.
Results: In total, 364 pharmacists participated in the study, of which 173 (47.5%) were females and 191 (52.5%) were males. The average age of the participants was 37.9 ± 10.4 years, and their average work experience was 11.2 ± 8.9 years. Of the participants, 333 (91.5%) had a Pharm.D. degree.
The mean (±SD) score of knowledge was 10.49 ± 2.17. Six participants (1.6%) had a poor knowledge level, 156 (42.9%) had an average knowledge level, and 202 (55.5%) had a good knowledge level.
On average, 69.0% of the participants agreed with positive attitude statements, whereas 51.9% did not agree with negative attitudes. The average score obtained from the attitude part was 1.4 ± 2.7. More than half of the participants believed that due to the lack of fee-for-service payment, providing smoking cessation consultations was not associated with economic incentives.
More than half of the participants stated that they provide smoking cessation consultations to smokers in their daily practice.
Less than a quarter of the pharmacists (90, 24.7%) had received formal education on smoking cessation interventions, and the majority (314, 86.3%) were willing to receive such education.
The highest level of confidence of the participants when counseling patients was regarding “providing information about the prescribed drugs” (67.3%), “training the patients about the health effects of smoking” (58.8%), and “recommendations regarding OTC drugs for smoking cessation” (53.0%).
There was a significant relationship between older pharmacists’ age and good level of knowledge (59.2% of older versus 45.1% of younger pharmacists, p = 0.01). Moreover, a significant difference was observed between the good level of knowledge and smoking status of the participants (63.9% of smokers and 50.4% of non-smokers, p = 0.01).
Male pharmacists (p = 0.02), older pharmacists (p = 0.04), and those with higher knowledge scores (p = 0.001) had significantly more positive attitudes about smoking cessation interventions.
Discussion: In this study, more than half of the participants had a “good” level of knowledge. This finding is in agreement with those of a systematic review by Kristina et al., which showed adequate knowledge of pharmacists regarding smoking cessation (12).
Our participants had a positive attitude toward smoking cessation counseling at the pharmacy. This finding was also observed in previous studies (12, 15). Of note, more than half of the participants stated that the lack of fee-for-service payment was a significant barrier to providing patient counseling. This was reflected in the finding that despite an acceptable level of knowledge, the participants’ routine work performance was modest. Therefore, the implementation of this fee may promote patient counseling.
In summary, despite an acceptable level of knowledge and positive attitudes, the practice of pharmacists in providing smoking cessation counseling was at an average level. The provision of economic incentives could be helpful in this regard.
Helping people with nicotine addiction is the main purpose of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to protect the population from the devastating health effects of tobacco consumption (7).
Pharmacists, as one of the most accessible healthcare providers, are well positioned to provide smoking cessation counseling. Smokers with underlying chronic medical conditions frequently visit pharmacies for medication. In this situation, pharmacists have a special opportunity to encourage, motivate, conduct behavioral therapy, and recommend the use of non-prescription medicinal items to quit smoking (8).
Considering the high frequency of smoking in Iran and the capacity of community pharmacies to support smoking cessation, this study was conducted to evaluate the knowledge, attitudes, and practice of Iranian pharmacists regarding smoking cessation services.
Methods: The current research was a cross-sectional study of Iranian pharmacists between 2021 and 2022. The Research Ethics Committee of Alborz University of Medical Sciences approved the study (IR.ABZUMS.REC. 1400.169).
A questionnaire was prepared based on a previous study (10), and then it was translated into Persian using the forward-backward translation method adapted from the Beaton et al. study (11). The validity of the questionnaire was confirmed with a content validity ratio (CVR) of 0.9 and a content validity index (CVI) of 0.88. The questionnaire reliability was confirmed by calculating Cronbach’s alpha = 0.94. The final version of the questionnaire contained six parts: demographic information, questions on knowledge, attitude, practice, educational history/self-confidence, and existing obstacles. The questionnaire was uploaded to the Epoll online platform, and its link was provided to the pharmacists through the provincial virtual networks of the Iranian Pharmacists Association.
The “knowledge” part of the questionnaire included 15 questions on interventions and prescription and OTC drugs used for smoking cessation. To evaluate the participants’ knowledge level, a score of 11 or higher was considered a “good” level, a score of 6-10 was an “average” level, and a score of 5 or less was a “weak” level of knowledge.
The attitude section included two statements on positive attitudes, three statements on negative attitudes, and one statement on economic attitudes. The participants were asked to express their opinion as “agree”, “disagree”, or “no opinion”. A score of +1 was considered for agreeing with positive statements or disagreeing with negative ones, a score of -1 for the opposite condition, and a score of 0 in the case of “no opinion”. The range of points that could be obtained in this part was between -5 and +5.
Data analysis was conducted using IBM SPSS Statistics for Windows, Version 16. The chi-square test was used to assess the relationship between knowledge and the study variables. The relationship between attitudes and study variables was investigated using the Mann–Whitney test.
Results: In total, 364 pharmacists participated in the study, of which 173 (47.5%) were females and 191 (52.5%) were males. The average age of the participants was 37.9 ± 10.4 years, and their average work experience was 11.2 ± 8.9 years. Of the participants, 333 (91.5%) had a Pharm.D. degree.
The mean (±SD) score of knowledge was 10.49 ± 2.17. Six participants (1.6%) had a poor knowledge level, 156 (42.9%) had an average knowledge level, and 202 (55.5%) had a good knowledge level.
On average, 69.0% of the participants agreed with positive attitude statements, whereas 51.9% did not agree with negative attitudes. The average score obtained from the attitude part was 1.4 ± 2.7. More than half of the participants believed that due to the lack of fee-for-service payment, providing smoking cessation consultations was not associated with economic incentives.
More than half of the participants stated that they provide smoking cessation consultations to smokers in their daily practice.
Less than a quarter of the pharmacists (90, 24.7%) had received formal education on smoking cessation interventions, and the majority (314, 86.3%) were willing to receive such education.
The highest level of confidence of the participants when counseling patients was regarding “providing information about the prescribed drugs” (67.3%), “training the patients about the health effects of smoking” (58.8%), and “recommendations regarding OTC drugs for smoking cessation” (53.0%).
There was a significant relationship between older pharmacists’ age and good level of knowledge (59.2% of older versus 45.1% of younger pharmacists, p = 0.01). Moreover, a significant difference was observed between the good level of knowledge and smoking status of the participants (63.9% of smokers and 50.4% of non-smokers, p = 0.01).
Male pharmacists (p = 0.02), older pharmacists (p = 0.04), and those with higher knowledge scores (p = 0.001) had significantly more positive attitudes about smoking cessation interventions.
Discussion: In this study, more than half of the participants had a “good” level of knowledge. This finding is in agreement with those of a systematic review by Kristina et al., which showed adequate knowledge of pharmacists regarding smoking cessation (12).
Our participants had a positive attitude toward smoking cessation counseling at the pharmacy. This finding was also observed in previous studies (12, 15). Of note, more than half of the participants stated that the lack of fee-for-service payment was a significant barrier to providing patient counseling. This was reflected in the finding that despite an acceptable level of knowledge, the participants’ routine work performance was modest. Therefore, the implementation of this fee may promote patient counseling.
In summary, despite an acceptable level of knowledge and positive attitudes, the practice of pharmacists in providing smoking cessation counseling was at an average level. The provision of economic incentives could be helpful in this regard.
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