|Year : 2016 | Volume
| Issue : 3 | Page : 140-145
Attitudes, practices, and barriers in tobacco cessation counselling among dentists of Ahmedabad city, India
Sujal Parkar1, Ekta Pandya2, Abhishek Sharma3
1 Department of Public Health Dentistry, Siddhpur Dental College and Hospital, Patan, Gujarat, India
2 Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gandhinagar, Gujarat, India
3 Department of Public Health Dentistry, Government Dental College and Hospital, Jaipur, Rajasthan, India
|Date of Web Publication||22-Aug-2016|
B-25 Krishna Bunglows-I, Gandhinagar Highway, Motera, Ahmedabad - 380 005, Gujarat
Aim: The aim of this study is to investigate the attitudes and practices of dentists from Ahmedabad with respect to their roles in tobacco cessation counselling and to find the barriers to such activity that prevents them to do so. Materials and Methods: A total of 150 dentists of Ahmedabad city were contacted at their dental office. The questionnaire was given to them and the responses were recorded. The questionnaire comprised of demographic details and 13-item questionnaire related to attitudes, practices, and barriers among dentists for tobacco cessation counselling. The frequencies of the responses were calculated, and the variables were compared using Chi-square test. Results: A total of 121 questionnaires were returned with the response rate of 80.66%. Out of 121 respondents, 60 (49.6%) were male dentists and 61 (50.4%) were female dentists. Age of dentists varied from 23 to 46 years, with mean age of 31.21 ± 7.31 years. Most of the dentists strongly believed that it is their responsibility to educate the patients regarding tobacco cessation counselling. More than half of the participant dentists do satisfactory tobacco cessation counselling during their dental practice. They feel restrained when it comes to prescribing nicotine replacement therapy. The lack of proper training was found to be the major barrier for tobacco cessation counselling. Conclusion: Dentist has a positive attitude for tobacco cessation counselling, but lack of proper training is a significant barrier for their failure. Hence, dentists should be given proper training for tobacco cessation counselling during their studies or continuing dental education programs should be arranged.
Keywords: Attitude, dentist, practice, questionnaire study, tobacco cessation
|How to cite this article:|
Parkar S, Pandya E, Sharma A. Attitudes, practices, and barriers in tobacco cessation counselling among dentists of Ahmedabad city, India. SRM J Res Dent Sci 2016;7:140-5
|How to cite this URL:|
Parkar S, Pandya E, Sharma A. Attitudes, practices, and barriers in tobacco cessation counselling among dentists of Ahmedabad city, India. SRM J Res Dent Sci [serial online] 2016 [cited 2021 Jan 16];7:140-5. Available from: https://www.srmjrds.in/text.asp?2016/7/3/140/188798
| Introduction|| |
Globally, tobacco use remains the leading preventable risk factor for premature morbidity and mortality. Tobacco has been reported to cause nearly 5 million deaths per year or one death every 6.5 s. Tobacco use in the form of smoking and smokeless is harmful to all human biological systems, including the oral cavity. It is a major contributor to oral cancer, periodontal diseases and is a significant risk factor for failed dental therapy.,, Other effects relevant to dentistry are staining of teeth and dental restorations, as well as congenital defects such as oral clefts if expectant mothers smoke.,,
One of the strategies to reduce morbidity and the number of tobacco-related mortality is to encourage the involvement of health professionals in tobacco cessation counselling. Dentists are in an ideal place to deliver tobacco cessation advice with readily visible changes in oral status. Dental visits offer excellent opportunities for dentists to offer tobacco cessation counseling as relevant adverse effects of tobacco on oral health (such as mucosal changes, halitosis, and other aesthetic concerns). Dental treatment often necessitates frequent contact with patients over an extended period, providing a mechanism for long-term contact and reinforcement.
Previous literature ,, regarding barriers for tobacco cessation practice among dentists includes doubt about knowledge and skills in assisting patients to quit habit, lack of confidence in their own ability to help their patients to quit, doubts about their effectiveness to give quit advice, anticipated negative reaction from patients, uncertainty about their role in smoking cessation, lack of educational materials, lack of time, and lack of remuneration.
To the best of our knowledge, there is no such information available on tobacco cessation and the role of dentists of Ahmedabad city, in particular, it is essential to view the current local status as to what dentists have done, are doing, and want to do. Thus, a questionnaire survey was conducted to assess the attitudes of the dentists of Ahmedabad with respect to their roles in tobacco cessation counselling, to investigate their current practice in this respect, and to identify the barriers to such activity that prevents them to do so.
| Materials and Methods|| |
A cross-sectional survey was carried out among the 150 dentists of Ahmedabad city. Before conducting the study, the research protocol was submitted to the Ethics Committee of Ahmedabad Dental College and Hospital and the approval to conduct the study was obtained. Ahmedabad city was divided into five zones: North, West, East, South, and Central. To make the sample more representative, thirty dentists were selected randomly using lottery method from each zone. The survey was scheduled to spread over a period of 6 months. A detailed weekly schedule was prepared well in advance. Although a detailed schedule was prepared meticulously, few adjustments and changes were done due to logistic reasons. Two days in a week was allotted for conducting the study. The purpose and procedure of the study were informed to each participant dentist and those dentists who are willing to participate in the study had given their informed consent.
Data were collected using self-designed questionnaire. The questionnaire was developed in English. The questionnaire consisted of two sections: Section 1 has personal details of participating dentist such as age, gender, and qualification while Section 2 consists of 13-item questions about attitude, practices, and barriers of dentist regarding tobacco cessation counseling. The questions are based on 5-point Likert scale which includes strongly agree, agree, neutral, disagree, and strongly disagree. Prior appointment was taken through telephone, and later, the dentists were contacted as per their convenient time. Questionnaire was administered by the investigator (PE) to each participant dentist, and the dentists were interviewed face-to-face.
The reliability of the questionnaire was assessed using Cronbach's alpha coefficient. Those questionnaires which were completely filled were considered for the analysis. The data were analyzed by applying descriptive and inferential statistical analysis as and when appropriate. Chi-square test was used to check the association among the qualitative variables. Analysis was carried out using Statistical Package for Social Science (SPSS) version 17 (SPSS Inc., Chicago, IL, USA). The level of significance was kept at 5%.
| Results|| |
Out of 150 dentists, 121 dentists had fulfilled the requirements and filled the questionnaire completely; hence, the remaining 29 questionnaires had been excluded from the statistical analysis. The value for Cronbach's alpha coefficient was found to be 0.85, suggesting strong reliability. Out of the 121 participants, 60 (49.6%) were male dentists and 61 (50.4%) were female dentists. Age of dentists ranges from 23 to 46 years, with mean age of 31.21 ± 7.31 years. Out of 121 dentists, 73 (60.33%) dentists were below 30 years of age. A total of 80 (66.1%) participant dentists were Bachelor of Dental Surgery (BDS) and 41 (33.9%) dentists were Master of Dental Surgery (MDS).
Majority of the dentists have a strong attitude for educating their patients regarding the risk of tobacco use to overall health (n = 91, 75.2%) and oral health (n = 83, 68.6%). More than half of dentists (60.3%, n = 73) strongly consider encouraging the patients to quit tobacco habit as their responsibility. The young dentists showed a highly significant (P < 0.001) interest in educating and encouraging the patients to quit the tobacco habit [Table 1].
Considering the tobacco cessation practice [Table 2], more than half of the dentists do a satisfactory practice. The BDS dentists inquired about the usage of tobacco more often as compared to the MDS dentists, which was statistically significant (P = 0.009). The young and female dentists significantly (P < 0.05) advised and discussed different strategies to quit tobacco habit with their patients. In addition, there was a gender-wise significant result (P < 0.05), when the dentists were inquired about their view of referring the patients to the tobacco cessation clinic. The female dentists play a significant role as compared to their male counterpart in the subsequent follow-up of the patients.
Few dentists, i.e., 24% (n = 29) agreed to the statement that dental professional's time can be better spent in doing tobacco counseling. Among 121 dentists, 24.8% (n = 30) of the dentists had fear of losing the patients during follow-up if they do counselling in the first visit while 76.9% (n = 93) of the dentists cannot do proper counselling as they believe that there is a lack of training in tobacco cessation counselling. The significant difference (P < 0.05) for different variables for barriers in tobacco cessation activity is shown in [Table 3].
| Discussion|| |
An investigation by Gordon and Severson  stated that the dental professional should play an important role in tobacco cessation activities within their clinical setup. The present study has provided interesting information about the attitude and the current practice among dentists of Ahmedabad city regarding tobacco cessation as well as various barriers met during their practice. The result of this study has also offered encouraging views of dentists' current activities and the opportunities for future involvement in smoking control. The direct comparison and contrast between the findings of this study with previous studies are difficult as various studies have done the assessment using varieties of questionnaires at different setups.
Nearly half of the dentists in this study believe that it is their responsibility to educate the patients regarding the risk associated with the tobacco use for overall health and the oral health and to encourage the patients to quit the tobacco use. These findings are in consistent with other surveys having the nearly same purpose conducted in the UK, Canada, Malaysia, the USA, Saudi Arabia, and Australia. In such countries, the adverse impact of tobacco on oral and general health is learned through problem-based learning tutorials during their current bachelor's curriculum. However, in India, there are very limited practical and hands-on training on the process of tobacco cessation. Hence, more practical training in helping patients on tobacco cessation should be included in the dental curriculum. Although their attitude was found very strong toward tobacco counselling, still there was a lack in effective practices regarding tobacco cessation counselling. In contrast to the encouraging attitude, the dentists were not much confident in tobacco cessation counselling.
In this study, all the dentists reported that they asked their patients routinely about their tobacco consumption. There were significant differences between ages and genders regarding advising their patients to quit tobacco habit. Most of the dentists providing this service, this was the most often provided step, for tobacco cessation possibly because advising patients to quit tobacco habit is becoming a standard of practice and is increasingly expected by patients who have tobacco habit in any form. In attempt to encourage health-care providers to become more involved in tobacco cessation, a simple yet effective protocol that can be used in a busy practice was introduced. The U.S. Department of Health and Human Services, in the 2000 guideline on Treating Tobacco Use and Dependence, recommended a counseling protocol known as the “5A's” to identify individual who wants to quit and how best to support him/her in their attempt. The “5A's” protocol, which consists of asking about the tobacco use, advising the benefits of quitting, assessing the motivation to quit, assisting in the quit attempt, and arranging for supportive follow-up, was developed based on comprehensive review of up to 6000 articles on tobacco addiction published from 1975 to 1999. The protocol was designed to be brief such that minimal counselling time is required, which was estimated to be only 3 min or less of direct clinician time.
Good numbers of dentists were practicing a high level of patient-based activities regarding tobacco cessation. Data from around the world suggest that up to half of all dentists advise their patients and suggest methods to quit tobacco.,, However, a study from India suggest that most dentists did not ask for or suggest methods to quit tobacco.
While interviewing with the dentists, it was revealed (data not presented) that the common strategies for tobacco cessation in their routine practice include discussing health hazards of tobacco use, discussing the benefits of discontinuing the use of tobacco, follow-ups, referring to patients to tobacco cessation clinic, and discussing the use of nicotine replacement therapy. Very few dentists assist their patients to quit the tobacco using health education materials such as brochure, posters, and videos in their clinical practice. The female dentists provide more tobacco cessation service as compared to their male counterpart which was statistically significant. This finding was consistence with the survey conducted by Brothwell and Gelskey, Razavi et al., and Lu et al. However, it is uncertain why female dentists provide more tobacco cessation services than male dentists.
It was agreed by few dentists that too much time was spent on providing routine dental treatments such that it was almost impossible to give tobacco cessation counselling to their patients. Similar responses were found in studies conducted by Stacey et al. and Albert et al. For this reason, majority of dentists in this study thought it was better to refer smokers to a smoking cessation expert or quit-smoking clinics, and this was in line with study conducted by Trotter et al. It is important to find out what techniques dentists use to influence tobacco habits and how effective they are. This study indicates that dentists seldom know whether or not their efforts work probably because they have taken few opportunities to do systematic follow-up.
Inadequate time, lack of training, and fear of losing the patient due to counseling were the important barriers faced by dentists. The results of the present study showed that the nearly half of the participant dentists believes that the major constraint for providing tobacco cessation counseling was lack of training, which was also noted in the dentistry training in Australia  and Hongkong. Continuing education and training for tobacco cessation should be organized by the government and health department. Studies have shown that dentists trained in tobacco cessation counselling were able to contribute to tobacco cessation programs in the community with good success rates, comparable to the rates reported in general practice settings.,
Regarding inadequate training for dentists in Ahmedabad, an organized training program directed at them should be launched as a part of continuing education for the practicing dentists. Enthusiastic promotions of training may boost the confidence of Ahmedabad dentists to become involved in tobacco cessation counseling and in turn may help them take a more active role in such counseling. Based on findings of this study, the training program should be focused more on male dentists. Tobacco cessation guidelines should also incorporate the “5As” or “5Rs” (i.e., relevance, risks, rewards, roadblocks, and repetition), which constitute the gold standard adopted in the UK, USA, New Zealand, elsewhere.
The present study provided an interesting insight into the attitudes and practices related to tobacco cessation counseling as well as various barriers encountered by the dentists of Ahmedabad city during their clinical practice. However, there are certain limitations of the study such as information obtained through self-administered questionnaire have to be interpreted with caution due to bias created through favorable responses. It is possible that dentists who agreed to participate or completed and returned the questionnaire were more interested in the issue as compared to those who did not participate, resulting in possible overestimation of positive responses.
| Conclusion|| |
Within the limitation of the study, it can be concluded that the dentists have a positive attitude for tobacco cessation counselling, but lack of proper training is a significant barrier for their failure. Hence, there is a clear need to provide dentists with information on the resources available to them. Provision of clear guidelines on the effectiveness of brief advice to quit may assist in addressing the barriers caused by lack of time and perceived lack of skills.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]