Institute of Social Medical Studies project develops, disseminates health provider TDT training program in Vietnam

The Develop and disseminate an evidence-based healthcare professional training program tobacco use treatment in Viet Nam project was conducted in collaboration with VINACOSH (Viet Nam’s MOH Tobacco Control Program) and Bach Mai Hospital, with technical support from New York University School of Medicine.

Based on the Global Adult Tobacco Survey (GATS), almost half of adult men are current smokers, a smoking prevalence that is the second highest among South East Asian countries (SEAC). Although Viet Nam has a strong public health delivery system, according to the 2010 GATS, services to treat tobacco dependence are not readily available to smokers or integrated into the health care system. The dearth of effective tobacco cessation services in Viet Nam is not the result of a lack of commitment to tobacco control. The government ratified the FCTC in 2004 and has enacted an ambitious National Tobacco Control Action Plan for the Implementation of the FCTC. Notably, the Action Plan calls for integrating cessation services into national health and education programs and builds on the MOH 2011 Annual Review, which stated that strengthening the national infrastructure to ensure access to evidence-based cessation services is one of the MOH’s highest priorities.

In 2012, the Viet Nam National Assembly passed the first comprehensive tobacco control legislation that took effect in 2013. A key component of the law is the establishment of a dedicated Tobacco Control Fund to provide resources for tobacco cessation treatment and training health care providers to offer smoking cessation support. The law acknowledges gaps in training and the need to increase knowledge and expertise among health care workers to effectively implement tobacco control goals.

In 2012, principal investigator Nam Nguyen, MD, DrPH and Donna Shelley, MD, MPH conducted the first study in Viet Nam to characterize current cessation intervention practices and examine behavioral and organizational factors that may influence adherence to recommended guidelines for treating tobacco use among health care providers working in commune health centers in Viet Nam (Shelley & Nguyen 2013). They found that providers, despite having positive attitudes toward delivering smoking cessation treatment, lacked the training they needed to help their patients quit. In order to increase provider-delivered cessation interventions, a program that offered training for physicians and allied health professionals working in commune health centers (CHCs) and hospitals was urgently needed.

This project marks an important step toward closing the knowledge and practice gaps among providers, and advances the goals of Viet Nam’s new tobacco control law. It has built much-needed capacity among provider organizations and the Ministry of Health to disseminate tobacco use treatment-related education and training programs throughout public health care delivery system in Viet Nam.

Methods:

  1. Core training curriculum for tobacco use treatment
    • This included (in English & Vietnamese) PPTs, handouts, supporting materials developed based on ATTUD core competencies for evidence-based treatment of tobacco dependence, PHS Clinical Practice Guideline Update: Treating Tobacco Use and dependence, WHO TTT curriculum on Strengthening health system for treatment tobacco dependence in primary care, VQUIT project/ISMS training materials (funded by NCI-NIH USA) and VINACOSH training materials.
    • The core curriculum was adapted based on consultation with an expert advisory group, interview results with health providers at commune health centers, then revised and finalized based on evaluation results from the trainings for 100 health care providers in Thai Nguyen province.
  2. Created capacity by developing and implementing a TTT model
    • Developed and tested the training of master trainer model
      1. Developed a 5-day TTT training program, self-help training materials and training manual; Conducted training of master trainers; Master trainers conducted training for 200 health providers in 5 districts.
    • Developed and implemented a web-based program
      1. Developed and uploaded online training materials and made those materials available for all health providers nationwide via: www.vquit.vn designed and executed by ISMS.
  1. Evaluation
    • Evaluation of the core curriculum training with 300 health care providers in 5 districts of Thai Nguyen province
      1. Conducted training session observations using assessment form with note-taking instructions; Conducted pre-and-post tests of participants using self-administered questionnaire; Analysed results employing EpiData software for data entry and SPSS for data analysis.
    • Assessment of post-training sustained practice changes to measure increased rates of screening for tobacco use and delivery of cessation assistance using 4As framework, and improvements in knowledge, attitudes and confidence of health providers to screen for tobacco use and assist smokers in quitting by using survey tool which was tested in over 100 health providers (Shelley & Nguyen, 2013).
      1. Conducted baseline (pre-training test) survey all participants attended training at the first day of the training; conducted phone survey at 3 months after training with all participants attended the trainings.
    • Dissemination of the evidence-based training curriculum and evaluation results

The lasting impact of this project affected a wide range of stakeholders, who increasingly became more aware of the necessity and relevance of tobacco cessation. National master trainers were trained on tobacco use treatment and healthcare providers gained more knowledge, skills and confidence to provide smoking cessation counseling and treatment to patients. Providers increased their use of tobacco dependence treatment practices and a tobacco use treatment network, utilizing the TTT curriculum, was created and expanded from the central level to provincial levels.

ISMS is now a lead member of the MOH Tobacco Cessation Technical Group, which consist of members from MOH, VINACOSH, Bach Mai Hospital, University of Medicine and Pharmacy in HCMC, Hospital of the University of Medicine and Pharmacy in HCMC, and WHO in Viet Nam.

Learn more about the project on the Global Bridges Resources page: