Effectiveness of online training in improving primary care doctors’ competency in brief tobacco interventions: A cluster-randomized controlled trial of WHO modules in Delta State, Nigeria

Abstract

Background The World Health Organization (WHO) strongly recommends that brief tobacco interventions should be routinely offered in primary care. However, medical doctors do not consistently and effectively intervene during their encounters with cigarette smokers. There is a paucity of studies assessing the effect of training on the tobacco intervention competency of primary care doctors in Nigeria. Aim To evaluate the effectiveness of online training in improving competency in brief tobacco interventions among primary care doctors in Delta State, Nigeria. Methods A cluster-randomized controlled trial was conducted among eligible doctors working in government-owned facilities. The 22 eligible Local Government Areas (LGAs) served as clusters. The intervention group received a WHO six-hour online course on brief tobacco cessation intervention, delivered via Zoom. The control group received no intervention. A structured questionnaire was sent to participants via WhatsApp before and six months after the training. The primary outcome variables were scores for knowledge, attitude, self-efficacy, and practice. Differences in change of scores between intervention and control groups were assessed with t-test. To adjust for clustering, these inter-group differences were further analyzed using linear mixed-effects regression modeling with study condition modeled as a fixed effect, and LGA of practice entered as a random effect. Results The intervention group had a significantly higher mean of change in scores for knowledge (effect size 0.344) and confidence (effect size 0.52). Conclusion The study shows that training, even online, positively affects clinician competency in brief tobacco intervention. This is important for primary care systems in developing countries. Mandatory in-service training and promotion of the WHO modules are recommended.