Development of the very brief advice intervention
The module being evaluated in this research is a 30-minute online training module developed by clinicians and academics to assist all health and social care professionals who work with children and families to raise the issue of SHS and promote action to reduce exposure in the home and car. The approach was adapted from a similar evidence-based training module [12] on delivering very brief advice on smoking for general practitioners and based upon a meta-analysis of brief smoking cessation interventions [13]. The NCSCT has developed a methodology for identifying evidence-based behaviour change techniques [14] and an analysis of the content of the module revealed the presence of 19 (of 71) such techniques, as described elsewhere [11]. The training is based around a promotional film, short film clips demonstrating possible interactions with families, plus facts, figures and strategies to help build knowledge and skills in this area. The module provides accessible information on four key themes: (1) the harms caused by SHS, (2) why it is important to raise the issue, (3) how to ask, advise and act, and (4) encouraging and supporting behaviour change. A short assessment (multiple-choice questions (MCQs)) forms part of the training and a certificate is issued following successful completion.
Evaluation of the training module
All participants who accessed the very brief advice for SHS training homepage between the launch in April 2012 and March 2014 were invited to participate in an evaluation of the module prior to undertaking the training. This included information on what participating in the evaluation would involve and provided participants with a choice to opt in to the research and so written informed consent was not obtained.
Evaluation participants were not offered any type of incentive to take part. Those opting to participate were initially asked about: gender, age, profession, how long they have been in their current profession, and how long they have been in their current post. Following this, they were asked to rate how confident they felt in raising SHS with smoking families via the following three questions using a five point Likert scale: (1) strongly agree through to (5) strongly disagree:
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(1)
I am confident in raising the issue of secondhand smoke exposure with my clients
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(2)
I am confident in raising the idea of smoke-free homes and cars with my clients
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(3)
I am confident in my ability to offer practical help and support to my clients around making their home and car smoke-free
Prior to entering the training module, participants completed a knowledge test of ten MCQs multiple-choice questions. The knowledge test covered the five main components of delivering very brief advice:
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1.
Who should receive very brief advice on secondhand smoke
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2.
Dangers of secondhand smoke
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3.
Clients reactions to very brief advice on secondhand smoke
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4.
Ask/Advise element of very brief advice for secondhand smoke
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5.
Advise/Act element of very brief advice for secondhand smoke
We developed three similar MCQs questions for each section and then the training software was used to randomly draw two questions per section to generate a knowledge test comprising 10 MCQs for each participant. This process was used for the tests at all three time points and was done to minimise the risk of the test answers being shared amongst participants. At the end of the training a further 10 MCQs were completed and they were asked the same three confidence questions. Participants were contacted by email 3 months after accessing the training and asked to complete the same three confidence questions, 10 MCQs and a further question exploring whether their practice had been influenced by participating in the training:
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(1)
Has the very brief advice for SHS training module resulted in you improving the way you provide support to smoking parents and carers? (yes/no/unsure)
Analysis
An a priori pass mark of 80 % (correctly answering eight out of ten randomly selected questions) was set for the knowledge multiple-choice assessments at each time point. Binary variables (all answers correct for that knowledge component vs. one or more incorrect answers for that knowledge component) were computed for each of the five topics covered within the pool of 15 questions to allow an exploration of knowledge of the individual components covered in the very brief advice for SHS training module and if this varied over time. For the three questions on confidence, the combined percentage of participants who responded ‘agree’ or ‘strongly agree’ was computed. Descriptive statistics were used to describe the sample and McNemar tests used to examine differences between time points (pre vs. post, pre vs. follow up and post vs. follow up) for both knowledge and confidence. The level of statistical significance was set to p < 0.05 for all analyses.
Ethical considerations
Formal ethics approval was not required because the study was deemed to be a service evaluation.