Abstract
BACKGROUND: Primary care providers are uniquely positioned to initiate smoking cessation. We aimed to evaluate knowledge levels about the health effects of smoking and attitudes toward smoking and tobacco control activities among primary care providers. METHODS: In the cross-sectional and primary care-based study, self-administered surveys modified from the WHO Global Health Professional Survey 5A steps of smoking cessation practice (Ask, Advise, Assess, Assist and Arrange) were provided to primary care physicians (PCPhs) and nurses (PCNs). RESULTS: Respondents included 1182 PCPhs and 1063 PCNs. The proportions of current and former smokers were significantly higher among PCPhs than among PCNs (34.4 vs. 30.7 % and 14.0 vs. 10.1 %, respectively; both P < 0.001). We observed that 77.2 % of PCPhs and 58.4 % of PCNs always or rarely practiced an "Ask" step about their patients' smoking status (P < 0.001). One-third of PCPhs (33.8 %) stated that they always practiced an "Ask" step, whereas only 27.6 % of PCNs always did so in their practice (P < 0.001). A small minority of primary care providers had advised patients to quit smoking, although there was a significant difference in this between PCNs and PCPhs (8.4 vs. 15.6 %; P < 0.001). Most PCPhs considered themselves competent in advising about smoking interventions, but only a minority of PCNs did so (75.1 vs. 17.3 %; P < 0.001). Among barriers to tobacco intervention measures, lack of time was the item most commonly cited by PCPhs, whereas low patient priority was most commonly cited by PCNs (35.9 and 35.7 %; P < 0.001). CONCLUSIONS: Smoking intervention practice by primary care nurses was quite low. Lack of time and low patient priority were identified as barriers by primary care providers. Strategies by which primary care providers could improve tobacco control should be established.