Mediators of Change to Control Tobacco †MyAssignmenthelp.com

Question: Discuss about the Role of Medical Students as Mediators of Change to Control Tobacco Use among population. Answer: Background Tobacco is perhaps the only legally sold product that leads to death in one-half of its regular consumers. Out of the estimated 1.3 billion people who smoke, almost 650 million faces premature death as a result of it (Ali and Hay 2017). Smoking remains a major public health issue in Australia in spite of immense efforts put forward for controlling it. Every year, smoking is known to kill almost 15,000 Australians. The total social and economic costs borne by the country is $31.5 billion. As per the reports of Australian Bureau of Statistics (ABS) conducted in the year 2014-2015, 14.7% of the adult population in the country smoke on a daily basis. 31.4% of the population are known to be ex-smokers (health.gov.au 2017). Smoking cessation has been a priority in all parts of the country, and healthcare professionals from all levels have been involved in this matter.Research is being continually conducted to find out new methods by which patients can be motivated and encouraged to quit sm oking (Sharma et al. 2017). The valuable role and responsibility of physicians in smoking cessation efforts has been extensively documented. Well-researched literature points out that physicians have a crucial role in motivation of patients to quit smoking. Research has been taken extensively for understanding how a physician might contribute to increase the rate of smoking cessation (Stead et al. 2013). According to Keto et al. (2015) views on the effects of smoking cessation strategies have dramatically changed in the last few years. Physicians at present have a responsibility of acting as a non-smoking role model as the workplace of a physician directly as well as indirectly teaches skills for smoking cessation. Medical students to have a role in this regard, as pointed out by (Park et al. 2015). As per the authors, medical students can act as mediators of change for positive results of smoking cessation interventions. The most significant objective for a physician is to engage a patient in a direct communic ation that motivates them to quit smoking. The physician might require help from other professionals in achieving this, and who better than the medical students. With the help of medical students, physicians can make patients commit to quitting smoking after pharmacological and educational support. The hope is always there that together, they can reduce the burden of smoking in the community. Research rationale The intervention cited in this proposal would target medical students in the initial stages of counselling. The proposed intervention would provide a foundation for all medical students in stage specific counselling. This would prove to be a helping tool for physicians while they strive to motivate smokers to quit smoking. The rationale behind this research is that imparting proper education to medical students at early stages so that they develop counselling skills would reap numerous benefits. Future physicians would gain increased confidence while taking part in smoking cessation programs by taking help from medical students. The students can also help physicians who do not have adequate time for counselling patients at a community setting with a huge pool of patients. In addition, the students can act as a guiding source for patients who suffer health complications due to smoking, or for patients who are at high risk for developing a smoking habit. Research question The proposed research would address the following research question- What is the role of medical students as mediators of change for controlling tobacco use among the countrys population? Aims and hypothesis In conducting the proposed study, the objective is to accomplish the following set of specific aims- Aim 1- To carry out a comparison of the effectiveness of the stage specific smoking cessation counselling intervention and control intervention by the evaluation of the impact on the following patient outcomes at 1, 3, 6 and 12 months: a. Stage of change b. Quit rate c. Confidence in quitting d. Desire to quit e. Motivation to quit f. Nicotine independence. Aim 2- To carry out a comparison of the stage specific smoking cessation counselling intervention and control intervention by the evaluation of the impact on the following care processes rated by patients at 1, 3, 6 and 12 months: a. Satisfaction with the care provided to patients in relation to smoking cessation counselling b. Satisfaction with the care provided to patients in general. Hypothesis 1- Patients undergoing counselling by medical students have received training in stage specific smoking cessation counselling would exhibit higher quit rates, have improvement in their stage of change, have increased desire to quit smoking, have more confidence and motivation to quit smoking. They would also be less dependent on nicotine at 12 months. Hypothesis 2- Patients undergoing counselling by medical students having received training in smoking-specific behavioural counselling would exhibit greater satisfaction with both care quality measures at 12 months. Research methodology Study design For research to be successful and give rise to suitable inferences, it is imperative to select a suitable research methodology. The research design plays an important role deciding whether the research would hold credibility or not. The proposed research would be a randomised cross-over trial. This would be done with two smoking cessation counselling interventions. The first counselling intervention would include written materials, patient education and follow-up by students who had been given training in stage specific tobacco cessation methods. The second counselling intervention would include written materials, patient education and follow-up by students who had been given training in non-smoking cessation techniques (exercise techniques). According to Flick (2015) randomised, controlled crossover experiments are very much significant in health care. This is because, in such a study, the impact of confounding covariates is reduced. Setting The proposed research would be set at community practice sites in internal medicine and family medicine throughout the city of Armidale, Australia, where medical students attend weekly continuity sessions with physician preceptors. Participants The participants of the research would be first-year medical students. 100 such students would be considered for the study. 350 patients of age between 16 years and 30 years would be included in the study after screening them for whether they are visiting the students physician preceptor for matters related to smoking or not. They must meet the criteria of smoking one or more cigarettes daily in the past one week. Sampling method Students would be selected through random sampling by the day they attend their medicine course and get training for the two counselling processes. The second counselling technique would be taught to the students six months after the first counselling technique is taught. Random sampling would be justified for the research as it is easier to do such a sampling, and also there would a fair chance of all possible participants to get equal opportunities of being selected for the research (Panneerselvam 2014). Main outcome measures The main outcome measures for the proposed study would be the stage of change, quit rate, motivation to quit, the desire to quit, confidence to quit and nicotine dependency after 1, 3, 6 and 12 months. Process measures The process measures for the proposed study would be patient satisfaction with the care quality provided in relation to smoking cessation and satisfaction with care quality provided in general. Data collection tool Data collection tool must always be aligned with the research objectives. A close-ended questionnaire would be used for the data collection purpose. The questionnaire would encompass questions related to the main outcome measures and the process measures. The questionnaire would be handed over to the patients, and they would be given one week time for completing it. During this period they would be free to contact the researchers regarding any concerns they might face. The researchers would guide them to complete the questionnaire so as to extract the maximal information from them. With a close-ended Questionaire a number of advantages would be gained. These include the quick response of the participants, easy comparison of answers, easy statistical analysis and complete data extraction. Since smoking cessation is a sensitive topic, it is likely that respondents would be comfortable in answering close-ended questions. Less literate participants would not be at a disadvantage (Niaura 2017). Analysis Patient level analysis of the process measures and main outcome measures would be done for understanding the possible confounding factors. Logistic regression for dichotomous outcomes and linear regression would be used for continuous outcomes. Generalised estimating equations (GEE) and random effects modelling would allow the researchers to adjust for time-dependent covariates (Neuman 2016). Ethics Primary research needs to abide by ethical principles concerning human participants. For the proposed research, informed consent of the participants would be taken for taking part in the research. The medical students and the patients would be explained in details all the aims and objectives of the research. They would be ensured that their identities would not be revealed at any level and confidentiality of their personal information would be maintained. They would have the freedom to exit the data collection process whenever they feel like doing so (Flick 2015). Timeline Activity Month 1 2 3-4 5 6-9 10-12 13-14 Sampling of participants Training provided to patients Assessment of student behavioural counselling skills Recruitment of patients Counselling patients by phone Counselling patients in-person Data collection Data analysis Report preparation Dissemination of findings References Ali, R. and Hay, S., 2017. Smoking prevalence and attributable disease burden in 195 countries and territories, 19902015: a systematic analysis from the Global Burden of Disease Study 2015. Flick, U., 2015. Introducing research methodology: A beginner's guide to doing a research project. Sage. Health.gov.au. (2017). Department of Health | Tobacco Control key facts and figures. [online] Available at: https://www.health.gov.au/internet/main/publishing.nsf/content/tobacco-kff [Accessed 26 Jul. 2017]. Keto, J., Jokelainen, J., Timonen, M., Linden, K. and Ylisaukko-oja, T., 2015. Physicians discuss the risks of smoking with their patients, but seldom offer practical cessation support. Substance abuse treatment, prevention, and policy, 10(1), p.43. Neuman, W.L., 2016. Understanding research. Pearson. Niaura, R., 2017. Learning from our failures in smoking cessation research. Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd.. Park, E.R., Gareen, I.F., Japuntich, S., Lennes, I., Hyland, K., DeMello, S., Sicks, J.D. and Rigotti, N.A., 2015. Primary care provider-delivered smoking cessation interventions and smoking cessation among participants in the National Lung Screening Trial. JAMA internal medicine, 175(9), pp.1509-1516. Sharma, R., Meurk, C., Bell, S., Ford, P. and Gartner, C., 2017. Australian mental health care practitioners practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness. International Journal of Mental Health Nursing. Stead, L.F., Buitrago, D., Preciado, N., Sanchez, G., Hartmann?Boyce, J. and Lancaster, T., 2013. Physician advice for smoking cessation. The Cochrane Library.