ASSESSMENT OF SMOKING CESSATION TRAINING PROGRAMS IN EUROPE - KATHLEEN MCLOUGHLIN FOR THE IRISH HPH NETWORK.
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ASSESSMENT
OCTOBER 2006
OF SMOKING
CESSATION
REPORT
TRAINING
PROGRAMS
IN EUROPE
Report prepared by
Kathleen McLoughlin
For the Irish HPH Network.Assessment of Smoking Cessation
Training Programs in Europe
Project Co-ordinator:
Miriam Gunning
National SFHI Co-ordinator
Irish HPH Network
c/o Connolly Hospital
Blanchardstown
Dublin 15
IRELAND
Researcher:
Kathleen McLoughlin
Participating Countries:
Belgium, England, Estonia, Finland
France, Germany, Greece, Hungary
Ireland, Italy, Romania, Scotland
Slovenia, Spain, Sweden
This report was prepared in the framework of the ENSH project “Smoking Cessation
Training Courses in Europe” and received financial support from the European CommissionContents Acknowledgements Foreword 1. Introduction / Background to Assessment.. . . . . . . . . . . . . . . . . . . . . . . 6 2. Method.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3. Results.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 4. Discussion.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 5. Recommendations.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 6. Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 7. References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 8. Appendices.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Acknowledgements The ENSH would like to thank the project group of the Smoke Free Hospital Network with representation from: Belgium, England, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Ireland, Romania, Scotland, Slovenia, Spain and Sweden. The project group would like to thank all of the co-ordinators of the smoke free hospitals who took the time to complete the co-ordinator questionnaire and to circulate the training survey throughout sites in their countries. Thanks also to the Irish HPH Network who co-ordinated the survey and collated the data returned. And finally thanks to each training centre /course co-ordinator that took the time to complete the survey tool and share their work with others.
Foreword
There is overwhelming evidence for the in this project in which France, German,
effectiveness and cost effectiveness of Romania and the United Kingdom were key
treating tobacco dependence. Smoking partners.
cessation support delivered by healthcare
staff trained in smoking cessation The report contains information from
techniques can greatly benefit smokers fifteen European countries and reflects
who are trying to quit. Hospitals offer a the significant consideration that was
captive audience at a time of personal given in the development of the survey
vulnerability, which may make individuals tool to minimise language difficulties. The
more enthusiastic to contemplate change in tool identified existing National training
smoking habits. This window of opportunity standards, numbers, duration and core
has been widely recognised and many content of individual training courses,
health professionals working in hospitals evaluation processes, and accreditation of
throughout Europe are being offered courses to national structures as well as
training in smoking cessation techniques. contact details for all trainers listed. It must
Access to specific training in skills and be noted that the data collected contained
knowledge by appropriate healthcare a particular basis to courses focused
workers working in the hospital setting is primarily towards the hospital sector
therefore essential if a change in hospital and only contains the details returned
based practices is to be facilitated. to national co-ordinators in participating
countries.
The European Network of Smoke free
Hospitals (ENSH) sought as part of a work The report confines its recommendations
package for 2005/2006 to assess current to three distinctly recognisable levels
smoking cessation training courses across of common training from within the
Europe, examine their content and make participating countries i.e. Brief Intervention
recommendations both in relation to core Training, Smoking Cessation Training and
content and the suitability of courses for Train the Trainer Training. Furthermore, as
which hospital-based health professionals the focus of the report was for the hospital
and workers. Ireland took the lead role sector, it acknowledges that considerationForeword was not given to training programmes that are known to exist in other sectors, primarily community health services. Training courses were further analysed under four sub-headings of generic, maternity, mental health and drug abuse. This report, developed in conjunction with the First European Directory of Smoking Cessation Training Courses, is a useful resource to be used by national groups engaged in standards setting for smoking cessation training and by trainers with a remit to deliver smoking cessation training Miriam Gunning ENSH Coordinator - Ireland
1. Introduction/Background to the Assessment The European Network for Smoke-Free Hospitals and Maternity Services (ENSH) is a European partnership of 19 member countries that are committed to promoting the policy of smoke-free hospitals throughout their region. The Network was established in 1998 and is a European project co-financed by the EU. To date, the main achievements of the ENSH have been the establishment of a recognised process to monitor smoking in hospitals through the development of a European Code for Smoke Free Hospitals, the development of agreed standards and a comprehensive audit tool and hospital implementation guide. As part of the work package for 2005 – 2006, the ENSH highlighted the need to assess smoking cessation training programs available within Europe and to identify which health professionals such programs were open to. From this data a database and directory of courses would be prepared. EU funding was granted for 55% of the overall budget cost of e9,925 and funding was also made available through the Irish Health Promoting Hospitals Network to meet the final cost. The project was co-ordinated by the Irish HPH Network and carried out by a researcher appointed by the IHPH.
2. Method
A project group of smoke free hospital A workshop of this group was organised for
co-ordinators from countries across Europe September 2005 to discuss the methodology
was established in May 2005. This group required to assess smoking cessation
reviewed the evidence based literature training programs across ENSH member
on the core content for cessation training countries and a survey tool was designed.
programs and exchanged practice within
their own countries. The range of training The survey tool consisted of two self-
courses available was found to be extensive, administered questionnaires. One
however the group agreed that the survey questionnaire was designed for the
would focus specifically on three main types smoke free co-ordinators in each country
of training, as follows: (Appendix 1) and the second was for use
by training centres / hospitals currently
1. Brief Intervention providing smoking cessation training courses
This training aims to provide participants (Appendix 2). It was necessary for each
with a basic knowledge and skills centre to complete a separate questionnaire
necessary to deliver brief opportunistic for each of the courses they facilitated.
advice during routine consultation.
The co-ordinators questionnaire identified:
2. Smoking Cessation Training • Participating countries that had developed/
This training aims to provide participants with were in the process of developing national
the knowledge and skills base necessary to smoking cessation standards
run effective specialist cessation services,
either on a one to one or group basis. • The number of training centres within the
country providing smoking cessation
3. Train the Trainers training to hospital based healthcare staff
This training aims to provide trainers with
the knowledge and skills necessary to The training centre questionnaire identified:
further design, plan, deliver and evaluate Details of specific training courses available
appropriate smoking cessation training including duration, content, method of
courses for future participants. evaluation and target participants.2. Method The survey tool was sent to the Co-ordinators of Smoke Free Hospitals in each country as outlined on the ENSH database and the co-ordinators were asked to distribute the questionnaire to all centres within that country providing smoking cessation training for hospital based healthcare workers. Data was returned by fax, email and post to the IHPH Network, who co-ordinated the overall project and was then passed to a researcher for subsequent analysis.
3. Results 3.1 Response Rate A total of 16 countries were asked to take part in the assessment of smoking cessation training. Responses were received from 15 countries across Europe (Table 1). Countries Responding to the Smoking Cessation Training Survey Belgium Germany Romania England Greece Scotland Estonia Hungary Slovenia Finland Italy Spain France Ireland Sweden Table 1: Countries responding to the Smoking Cessation Training Survey.
3. Results
3.2 Co-ordinator Questionnaire
The quality of responses to the survey of co-ordinators and training centres differed in quality
and depth of information provided, making it difficult to compare situations across countries.
Table 2 highlights the responding countries, the presence of any national standards for
smoking cessation and the number of centres sent a questionnaire together with the total
number of courses identified in each country.
Country National Standards No. of Centres Number of Total Number of
for Smoking sent a Questionnaire Centres to Respond Courses Identified
Cessation Available?
Belgium No Uncertain 1 1
England No Uncertain 1 41
Estonia No 1 1 2 (+ local level courses)
Finland No 1 1 5
France Yes Uncertain 2 8
Germany No Too many to survey 1 9
individually
Greece No 1 1 3
Hungary Yes 1 1 1
Italy Yes 4 1 3
Ireland No 21 9 36
Romania Yes 5 5 7
Scotland Yes 14 5 86
Slovenia Unknown o (Courses at primary N/A 0
care level only)
Spain No 4 2 7
Sweden No (planning stage) 6 (Via tobacco prevention Examples of courses 4
units) obtained from centres and
individuals.
Table 2: Responses to Co-ordinators Questionnaire
1NOP survey in 2003 identified 24 courses. Feedback for this survey based on one area response.3. Results
3.2.1 Standards for Smoking Cessation Training
Of the 15 countries returning the co-ordinator questionnaire, 52 co-ordinators reported having
smoking cessation training standards present within their country (these are identified in Table
2). In addition, Sweden is currently developing standards and in Germany an expert group is
expected to publish quality criteria for smoking cessation training in the near future. In Ireland
standards have been drafted but due to health service restructuring they are awaiting sign off.
Of the 5 countries reporting to have standards for smoking cessation training in place, all have
standards at national level with the exception of Romania that has standards published at local
level. Of the 4 with standards published nationally, 3 of these countries have the standards
monitored nationally by the country. Table 3 provides more information about these standards.
Country Level Date Monitored Who is responsible for Monitoring?
Published by Country?
France National 1998, 2004/5 Yes OFT, RHST, SFT, APPRI
Hungary National 1994 Yes National Institute for Health Development. Network
of Smoking Cessation Clinics
Italy National 2000 No N/A
Romania Local Unknown No N/A
Scotland National Nov 2003 Yes PATH (a partnership between the Scottish Executive,
ASH Scotland, Health Scotland, the Convention of
Scottish Local Authorities and the health promotion
managers).
Table 3: Information regarding countries with Standards for Smoking cessation Training in place.
2 Hungary reportedly have standards for smoking professionals in smoking cessation do not exist per se,
cessation training in place, however, further examination of however, the co-ordinator has ticked yes to this question
accompanying text to the questionnaire indicates that these and Hungary is therefore included in the 5 countries
standards are general standards applying to family doctors reporting to have training standards for smoking cessation
to give advice to patients that smoke within their current in place at the time of survey but further clarification in
workload, so standards specifically related to training health Hungary may be required.3. Results
Smoking Cessation Training Courses
14 of the 15 countries surveyed returned In some countries e.g. Germany, it was not
specific information on smoking cessation possible to survey each site and report all
courses held in their country as outlined courses as the country co-ordinator felt
in Table 2. Slovenia replied to the survey that there were too many such courses
indicating that courses were run at available. In cases like this, a sample of
primary care level but no specific the available courses is presented in the
information was made available. Within Directory accompanying this report.
these 14 countries, a total of 176 courses
are described in detail. Unfortunately, not A breakdown of the type of training courses
all individual courses held in a single available in each country is shown on
centre were always recorded on separate Table 4 overleaf and Figure 1 shows that
sheets, so for some courses in some the number of smoking cessation courses
centres, the information is presented offered is almost equal to the number of
collectively. brief intervention training courses identified.
Figure 1: Breakdown of the type of training courses available.
7% 5%
44%
Brief Intervention
Smoking Cessation
44%
Other
Train the TrainersCountry No. of Brief Brief Brief Brief Smoking Smoking Smoking Smoking Train the Train the Train the Train the Other
Courses Intervention Intervention Intervention Intervention Cessation Cessation Cessation Cessation Trainers Trainers Trainers trainers
Training Training training Training Training Training Training Training (Generic) (Mental (Maternity) (Drug
(Generic) (Mental (Maternity) (Drug Abuse) (Generic) (Mental (Maternity) (Drug Health) Abuse)
Health) Health) abuse)
Belgium 1 x
England 4 x (2)
3. Results
Estonia 2 x (2)
Finland 5 x x x (3)
includes
courses
mixed styles
France 8 x x x x x Smoke
Free
Hospital
Process.
x(2) mixed
styles and x
multimedia
Germany 9 x x x x x x x x x
Greece 3 x x x
Hungary 1 x
Ireland 36 x (11) x x (7) x X (10) x x Intensive
3-day
course and
x(4) mixed
styles
Italy 3 x x x
Romania 7 X (2) x x (2) x x
Scotland 86 X (14) X (14) X (14) x (16) X (14) x (14)
Spain 7 X (2) x (3) x x
Sweden 4 x x x x
Country.
of Course
Respondent
Table 4: Types
offered in each3. Results
Brief Intervention Training Courses
Brief intervention training is available training in brief intervention appears to be
at differing levels in 12 of the countries standardised across centres and this may
reporting to provide smoking cessation relate to the smoking cessation standards
training. Generic brief intervention training present within these countries. In Scotland,
is most commonly available with such brief intervention training regardless of
courses being held in England, Finland, its focus lasts for one day and is aimed
France, Germany, Greece, Hungary, Ireland, at nursing staff, professional and non-
Italy, Romania, Scotland, Spain professional healthcare workers and care
and Sweden. workers. In Romania, brief intervention
courses took ½ day to complete and were
In addition to generic brief intervention aimed at both doctors (Consultants and
training, training in brief intervention NCHD’s) and nursing staff.
specific to mental health is available in
Germany, Ireland, Romania, Scotland and In Finland and Italy, generic brief
Sweden. In the maternity setting, specific intervention training is held on a ½ day
courses in brief intervention are available and in Spain and France the training takes
in Germany, Ireland and Scotland. Ireland 1 day. It is interesting to note the short
and Germany are the only countries offering timeframe for training in Italy, where courses
brief intervention specific to the needs of are aimed at Consultant Hospital Doctors,
drug abusers. and obviously takes into consideration their
time restraint for training of this nature.
The length of the brief intervention training
In Spain and Finland, brief intervention
courses offered differs between countries
training is open to all staff except non-
surveyed and within some countries in
professional healthcare workers. In
different centres. All brief intervention
Sweden, the generic brief intervention
courses listed were between ½ day and 2
training lasts for 2 days with a one day
days in length.
course for mental health and is open to
In Scotland and Romania, the length of nursing, and allied health professional staff.3. Results
In Ireland there is variation between sites less, with epidemiology, the role of the
with generic training lasting between 1 and health professional and addiction being
2 days, maternity training available for one core aspects of the course. The reduced
day and mental health training between 1 material in Italy’s course may reflect
and 2 days in length. Training in Ireland the shorter course duration of ½ a day
focuses on nursing and allied healthcare compared to one day in Scotland.
workers e.g. Physiotherapists, OT’s and
some NCHD’s also attend. Specific details about each brief
intervention course available in each
Respondents were asked to identify the country are available in the directory.
core aspects of the courses held in brief
intervention, and these are summarised
on Table 5. The table shows the country,
the type of course (where there is more
than one course of the same type, this
is denoted in brackets) and whether
each of the courses includes items such
as epidemiology smoking, models of
behaviour change and so on, as outlined on
the table. Where there is a X this indicates
that this element is part of the core content
of the course and where a number e.g. 1/3
is given this means that for one of the three
courses of this type in this country, that
element is a feature of the core content.
From the table it can be seen that most
of the brief intervention courses run in
Scotland contain all of the elements listed.
Italy’s brief intervention courses containCountry Type of Epidemiology Models of National & Methods of Alternative Motivational Role of health Managing Addiction, National stats
Course 3 of Smoking Behaviour International Coping with treatments / interviewing professional / Running nicotine and smoking
& Smoking- Change Guidelines and Withdrawal management techniques in smoking a smoking dependence cessation
Related Recommendations Symptoms of relapses cessation cessation & use of services in the
Disease group pharmacological national health
treatments system /
quality control.
England BITG X X - - - X X - X -
3. Results
Finland BITG - X - - - - X - X -
France BITG X X X X X X X X X
Germany BITG X X X X X X X - X -
BITMH X X X X X X X - X -
BITM X X X X X X X - X -
BITDA X X X X X X X - X -
Greece BITG X X X X X - X X X -
Hungary BITG X - X X X - X - X X
Ireland BITG (11) X (10) X (11) X (10) X (10) X(7) X (10) X (11) - X (10) X (7)
BITMH X X X X X X X - X X
BITM (7) X (6) X (7) X (6) X (7) X (6) X (5) x (7) - X (7) x (5)
BITDA - X - X X X X - X -
Italy BITG X - - - - - X - X -
Romania BITG (2) X (2) - ½ - ½ - ½ - ½ -
BITMH - - - - - - - - X -
Scotland BITG (14) X X X X X X X X X X
BITMH(14) X X X X X X X X X X
BITM (14) X X X X X X X X X X
Spain BITG (2) X (1) X (2) X (1) X (1) X (2) X (2) X (2) X (2) X (2) X (2)
Sweden BITG X X X X X X X X X -
BITMH X X X X X - - - X -
Total 79 34 35 31 32 30 29 37 8 38 19
Table 5: Core Content of Brief Intervention Courses offered in Europe.
3 BITG = Brief Intervention Training (Generic) / BITM = Brief Intervention (Maternity) / BITMH = Brief Intervention Training (Mental Health).3. Results
3.2.2 Smoking Cessation Training
Smoking cessation training courses smoking cessation training between
represent 43.8% of the courses listed in countries surveyed and there is also some
the survey. All countries listed in Table 3 variation within centres in the same country.
with the exception of Hungary and Slovenia In Italy, generic smoking cessation training
reported providing generic smoking lasts for ½ day compared to Belgium which
cessation training courses. In Finland, the runs a 7 day course. All smoking cessation
smoking cessation training course runs in training courses in France are between 1
tandem with brief intervention training as a and 2 days in duration, as are those held
training course for facilitators of smoking in Ireland. In Scotland, smoking cessation
cessation and as a course for staff in the training, regardless of its focus takes
central hospitals. Both of these courses are one day. In Estonia, smoking cessation
included in the “Other” column. training is held over 2 days for cessation
counsellors and 1 day for GPs. In Sweden
Smoking cessation training specifically
training lasts for 3 days (aimed mainly at
designed for the needs of mental health
nursing staff) and in Romania courses range
patients is available in France, Germany,
from 1 day to 4-6 days for generic smoking
Ireland, Scotland and Spain Galacia. In
cessation training and are aimed at hospital
Estonia, France, Germany and Scotland,
doctors and allied health professionals.
a course specifically for maternity service
staff is also available. In Germany and
Table 6 highlights the key elements within
Romania a smoking cessation course
each of the smoking cessation courses run
is available designed to meet the needs
in countries that returned data and it can
of staff working with drug abusers. The
be seen that the content of most courses is
Romanian course focusing on drug abuse is
very comprehensive, incorporating most of
targeted at hospital Consultants.
the elements listed.
There is considerable variation in the length
of smoking cessation training courses from
½ day to 7 days in duration for genericCountry Type of Epidemiology Models of National & Methods of Alternative Motivational Role of health Managing Addiction, nicotine National stats and
course 4 of Smoking Behaviour International Coping with treatments / interviewing professional / Running dependence smoking cessation
& Smoking- Change Guidelines and Withdrawal management techniques in smoking a smoking & use of services in the
Related Recommendations Symptoms of relapses cessation cessation pharmacological national health
Disease group treatments system / quality
control.
Belgium SCTG x x x x x x x x x x
England SCTG (2) x x (1) x x x x (1) x (1) x (1) x x
3. Results
Estonia SCTG x x - x - x x x x x
SCTM x x x x x x - x x x
France SCTG x x x x x x x x x x
SCTMH - x x x x x x x x -
SCTM x x x x x x x x x -
Germany SCTG x x x x x x x - x -
SCTMH x x x x x x x - x -
SCTM x x x x x x x - x -
SCTDA x x x x x x x - x -
Greece SCTG x x x x x - x x x -
Italy SCTG x - - - - - x - x -
Ireland SCTG (10) x (7) x (9) x (9) x (8) x (9) x (9) x (9) x (4) x (10) x (7)
SCTMH x x x x x x x - x x
Romania SCTG (16) x x (15) x x x (15) x (15) x x (14) x x
SCTGMH x x x x x x x x x x
(14) x x x x x x x x x x
SCTGM
(14)
Spain SCTG (3) x (1) x x (2) x (1) x (2) x x (1) - x (2) x (1)
SCTMH x x x x x x x x x x
Sweden SCTG x x x x x x x x x
Total 77 70 73 73 72 72 71 72 57 76 61
Table 6: Elements of Core Content in Each of the Smoking Cessation Training Courses in Each Country.
4 SCTG = Smoking Cessation Training (Generic) / SCTM = Smoking Cessation Training (Maternity) / SCTMH =
Smoking Cessation Training (Mental Health) / SCTDA = Smoking Cessation Training (Drug Abuse).3. Results 3.2.3 Train the Trainers Train the Trainer training in smoking treatments probably because their courses cessation was the least frequently are aimed solely at medics and professional mentioned course held in the countries healthcare workers. surveyed. Generic training is available in England, Finland, Germany and Greece, Italy, Romania, Spain and Sweden. Sweden has a dedicated Train the Trainer Course for maternity aimed at specialist nurses and allied health professional, courses in the other countries are generic in nature and open to a wide range of health professionals with the exception of Italy, where the course is aimed at hospital Consultants. Again, there is considerable variation in the length of the Train the Trainer programmes, with the Italian and Romanian courses taking ½ day to complete, the French course taking 1-2 days, 2 days for the course in Finland and 3 days for completion of the Swedish Train the Trainers programme. The difference in the length of the courses is apparent in the content of the courses, as shown in Table 7. The content of the courses held in Sweden and France is broader than that in Italy and Romania who focus on the role of health professional and pharmacological
Country Type of Epidemiology Models of National & Methods Alternative Motivational Role of Managing Addiction, National stats
course 5 of Smoking Behaviour International of Coping treatments / interviewing health / Running nicotine and smoking
& Smoking- Change Guidelines and with management techniques professional a smoking dependence cessation
Related Recommendations Withdrawal of relapses in smoking cessation & use of services in
Disease Symptoms cessation group pharmacological the national
treatments health system /
quality control.
England TTTG
3. Results
Finland TTTG x x x x x
Germany TTTG x x x x x x x x
Greece TTTG x x x x x x x x
italy TTTG x x x
Romania TTTG x x x x
Spain TTTG x x x x x x x x x x
Sweden TTTM x x x x x x x x x
Table 7: Elements of Core Content in the Train the trainer Programmes Offered in Europe.
5 TTTG = Train the Trainers (Generic). TTTDA = Train the Trainers (Drug Abuse). TTTM = Train the Trainers (Maternity)/3. Results
3.2.4 Other Courses
France, Finland and Ireland have courses on the level of detail returned in the
available that do not specifically fall into questionnaire. Generally, most of the
one distinct category of training type. In training courses are hospital based held
France a dedicated course is available in either in the hospital or in accompanying
the Smoke- Free Hospital process (length medical / nursing schools. In Ireland, there
of course not specified but between 1 is a dedicated Winter School providing
and 2 days), there are two courses with smoking cessation training, alongside work
mixed styles and one course “FASTER” is completed locally in hospitals. In Romania,
multimedia based. Detailed information training occurs in the form of workshops
about this course is available in the and through university programmes
Directory. In Ireland there is an intensive for doctors in training. There is also a
three day training aimed at people willing university E-Learning course available for
to deliver smoking cessation services on brief intervention training for mental health.
a sessional basis, this includes a one day France have submitted detailed information
brief intervention session and four courses on the “FASTER” E-learning training
utilising mixed approaches, and in Finland, course recently launched there and Greece
as noted earlier, there is a two day training also provide an E-Learning package. In
course for facilitators of smoking cessation Scotland, a national training centre is
which utilises multiple types of training as available (PATH) and this provides training
does the smoking cessation course for staff alongside that provided locally. Many of the
working in hospitals (half day). There is also questionnaires had “Other” ticked for the
a two day course for maternity service staff question relating to the method of teaching
which combines brief intervention training used and did not go on to specify so there
and smoking cessation. is a lack of clear data re: the method of
learning used for comparison between
Location / method of learning used countries and courses.
The details of each course in each country
are available in the Directory accompanying Course Evaluation
this report and vary in detail depending Respondents were asked whether course3. Results
participants were evaluated using skills, of the French Smoke Free Hospital Network
knowledge or a combination of both. Figure / Reseau Hopital sans Tabac, (RHST). In
2 shows that the majority of courses run are Hungary, both smoking cessation training
evaluated using a combination of skills and courses offered are accredited by the
knowledge assessment. National Association of Chest Physicians.
In Romania, most of the courses offered
Course Accreditation are accredited by the National College of
Figure 3 shows that one third of the courses Physicians. In Ireland some of the courses
run are accredited by a body within that are accredited by An Bord Altranis and
country. In Scotland, courses are approved in Estonia, courses are accredited by the
by PATH and those that are not, have National Institute for Health Development
specified that they intend to seek this through the HPH Co-ordinator. The
approval in the future. In France, all courses Scientific Committee of the FARES accredit
are accredited by the training department the course offered in Belgium.
Figure 2: Method of Course Evaluation Figure 3: Accreditiation Status of Courses
2% 4%
74% 67%
20% 33%
Skills Both Yes
Knowledge Not Recorded No/Unkown4. Discussion
This survey has generated a baseline picture offer for health professionals across Europe.
of some of the training courses in smoking The target participants for these courses differ
cessation offered in countries across Europe. across countries and this is reflected by the
It has certainly not provided information about length of some of the courses and elements of
each and every one as in some countries, e.g. core content. E.g. in Italy, courses are short with
Germany there were too many for the Co- a focused content probably because they are
ordinator to mention. Some returns for countries aimed at hospital consultants, for whom time is
offered an example of courses available e.g. in an important factor to ensure attendance.
Hungary and for some countries the response
was not complete. One third of the courses listed are accredited
or approved by a professional body which is
The questionnaire circulated to training centres encouraging. Participants can then be assured
for completion was useful to a point, however that the course they attend has a recognised
some centres did not complete a separate form content or format and those they will receive
for each course offered making if difficult for the some recognition for attending the programme.
researcher to establish whether the information However, more work needs to be done to
provided was the same for all of the courses design courses that are standardised and
listed on the sheet, and in cases such as this, recognised by a professional body to encourage
it was assumed that it was but this may have participants to attend.
been an oversight by the person completing
the form. In the future, it may be an option for Almost three quarters of the courses are also
training centres to complete their forms on-line evaluated using a combination of skills and
using a system that allows only one course to be knowledge based assessment ensuring that
recorded on each entry. The tool was available both the theory and practical nature of the
in a number of languages, but was completed course has been absorbed by participants.
in English for all countries with the exception of However, without the findings / results of these
Spain, who returned the Spanish version. evaluations, it is not possible to determine
how effective the courses run are in training
From the survey, it can be seen that there are professionals in smoking cessation and brief
a number of smoking cessation courses on intervention techniques.5. Recommendations
This report was developed to be used in tandem epidemiology of smoking & smoking related
with the Directory of Smoking Cessation Training to diagnosis including the effects of smoking
Courses. The directory of courses developed in pregnancy and environmental tobacco
from this survey is a starting point, and perhaps smoke (ETS) with a brief introduction to
its circulation throughout hospitals and countries inequalities with addiction areas. General
may encourage other centres to come forward for focus on the psychology of behaviour
inclusion in subsequent publications. change, benefits of quitting and reasons
why stopping smoking might be difficult.
Recommendations listed below are derived The course should also provide skills on
from the literature and from examination and communication, client centred approach,
discussion by the project group of the data assessment of a smoker and an overview of
available services and resources for quitters
analysed within this report.
locally, regionally or nationally as appropriate.
See box 1 for an outline of the core content
1. Directory:
recommended for this training.
The directory should be made available
electronically to allow for constant revision and Box 1: Brief Intervention Training
amendment and to reduce the cost of distribution.
Epidemiology of smoking & smoking
related to diagnosis
2. Access and core content:
Smoking in pregnancy
Recommendations are made with respect to ETS
access and the core content for three levels of Inequalities with addiction areas
training: Psychology of behaviour change
National guidelines / Policy context
Benefits of quitting
(a) Brief Intervention Training:
Reasons why stopping smoking might
This training should be accessible to all be difficult
healthcare staff working in the hospital Communication skills and client
setting for use in brief patient encounters. centred approach
As such the core content of the course Assessment of a smoker
Overview of available services and
should provide knowledge on national
resources for quitters
guidelines a policy context, cover the5. Recommendations
(b) Smoking Cessation Training: recommended for this training.
This training should be made
available to healthcare professionals Box 2 Smoking Cessation Training
who already have received brief
Smoking cessation treatments and
interventions training and are in a
their evidence base including
position to follow-up smokers and
pharmacological and alternative
referred clients to smoking cessation.
treatments
The focus of this training is on
Theories of addiction
providing a deeper understanding
Managing withdrawal symptoms
of smoking cessation treatments
Working with specific client groups
and their evidence base including
Carbon monoxide testing as a tool
pharmacological and alternative
for quitting
treatments, theories of addiction and
Managing patient’s expectations
on the management of withdrawal
Planning, managing and evaluating
symptoms. It also needs to provide
a cessation service including data
skills for working with specific client
collection and smoker follow-up
groups, carbon monoxide testing as
Providing smoking cessation
a tool for quitting, managing patient’s
group support
expectations and planning, managing
Advanced skills practice techniques
and evaluating a cessation service
and assessment of those skills
including data collection and smoker
Relapse prevention
follow-up. It also needs to cover how
Reflection of practice and professional
to provide smoking cessation group
development
support; advanced skills practice
Smoking cessation in content of overall
techniques and assessment of those
tobacco management
skills, relapse prevention, reflection of
practice and professional development
and smoking cessation in content of (c ) Train the Trainers:
overall tobacco management. See box This course is provided for
2 for an outline of the core content healthcare professionals with a5. Recommendations
training remit. Recruitment for this based professionals and healthcare
training could be at two levels: workers on three levels of training.
(a) Health Promotion Box 3 Train the Trainers
Professionals with a tobacco
The expert group felt that the requirements
remit, practitioners already
for a train the trainer’s course depended
engaged in the setting-up and
on what background the participants came
delivering of smoking cessation
from requiring the following expertise:
services along with future role in
further training, Teaching skills with a large focus on
management of addiction., with
(b) Tutors or trainers with a remit Participants coming from a Health
to further deliver smoking background requiring training skills
cessation training to healthcare Participants from a training
workers and/or other relevant background requiring health
groups. The training needs to information, relevant tobacco links,
provide the necessary skills and the overall national approach to
knowledge on how to plan, tobacco management etc.
recruit participants and further
deliver appropriate training
course in brief interventions
techniques & smoking cessation (a) Brief Intervention Training:
training to relevant groups. See The project group agreed that there
box 3 for an outline of the core was a value in providing this training
content recommend for this to all healthcare staff working in the
training. hospital setting, ideally this could
be delivered as a one-day training
3. Duration and suitability: but as staff release for training was
Recommendations are made with respect identified as a problem a half-day
to the duration and suitability of hospital training may be more appropriate.5. Recommendations
Mandatory brief interventions other healthcare facilities.
training for all hospital staff was Recommendations on duration:
agreed as the best possible future one to two day course
approach to comprehensive tobacco
management in the hospital setting (c) Regarding Train the Trainers
and training could be provided either courses the group felt that this
directly through the hospital or via course should be available nationally
regional training providers. to trainers who have a remit to further
Recommendations on duration: deliver either of the above courses. As
a half to full day course. the overall aim of a “Train the Trainers”
course is to ensure that all participants
(b) The group agreed that Smoking have the necessary skills and knowledge
Cessation Training should be made to plan, recruit participants and further
available to healthcare professionals deliver an appropriate training courses,
who had received brief interventions it is essential that needs of participant
Training, used their acquired skills on are assessed prior to the development
smokers, referred clients to smoking of each training package and the
cessation services and were content agreed with the relevant
interested in furthering their personal organisers before the delivery of the train
knowledge and skills to allow them the trainers programme. Duration of the
to deliver more intensive smoking training therefore may vary from
cessation services to clients in 2-7 days according to the specific
the future. Participants should have requirements. It was also felt that
time allocation for service delivery this course could be delivered by a
within their work remit. Recruitment partnership ie. A trainer with
for this training should be done at suitable training skills and a tobacco
organisational level but as numbers specialist with the health and
may be small the course could be practical background.
facilitated at regional level to Recommendations on duration:
facilitate a number of hospitals and two to seven day course5. Recommendations
Further Recommendations:
4. Tailoring training to meet the needs of specific client groups e.g. maternity, mental
health, drug abuser is necessary and further development of this practice should
continued
5. Refresher Train the Trainers courses should be made available nationally on an annual
basis to review and quality assure all training provided
6. The practice of using E-Learning as a method to overcome difficulty with staff release
for formal training should be given strong consideration.
7. Movement towards the accreditation of training courses by a national body is also
strongly endorsed.6. Conclusion The ENSH project group consider that valuable information and important recommendations are contained within this report and its associated directory. While, a specific hospital focus was adopted for the survey and report, it acknowledged the omission of smoking cessation training currently inbuilt into many community health services. The group strongly believe that this should only be a starting point and that through wide dissemination and usage, subsequent publications could take a broader view. It was also felt that training and professional practice need to merge to complete practice and that while national structures vary, the national plan for smoking cessation training and service delivery should be developed to compliment each other.
7. References
1. Helping Smokers Change, a resource Consultancy on behalf of the NHS Executive
pack for training health professionals, WHO South East – March 2000
2001
8. Raw, M.McNeill, A. West, R. Smoking
2. Standards for Smoking Cessation Cessation guidelines for health
Training in Scotland, Path, Scotland, professionals. A guide to effective smoking
November 2003 cessation interventions for the health care
system. Thorax 1998, Vol 53. Supplement 5
3. Health Development Agency Standard Part 1
for Training in Smoking Cessation
Treatments, London Health Development 9. West, R. McNeill, A.and Raw, M. (2000).
Agency 2003 Smoking cessation guidelines for health
professionals: an update. Thorax: 2000,
4. The Role of Health Professionals in 55: 987 - 999
Tobacco Control, WHO 2005
5. Helping Smokers to Stop – a teaching
resource for the dental team by Joanna
Dykes, Mary Robinson & Richard Watt
6. Department of Health, Social Services
and Public Safety Training Framework for
Smoking Cessation Services in Northern
Ireland Belfast: Department of Health, Social
Services and Public Safety 2003
7. Smoking Cessation Training
Framework – A report developed by
Camilla Peterken from the Health Promotion
Partnership and Tim Morrison from Foyle8. Appendix One
This Page Must Be Completed By The National Co-ordinator
Smoking Cessation Training Standards
Are there smoking cessation training standards in your country? Yes No
What is the total number of Training Centres / Agencies on your mailing list for this survey?
a) If YES, are the standards at:
i. National level
ii. Regional level
iii. Local level
iv. Other Please specify
b) Date that standards were published
If this information is not readily available were these standards published in the last:
i. Year
ii. 2 Years
iii. 5 Years
iv. > 5 Years
c) Are these standards monitored in your country? Yes No
If YES, please state the name of the monitoring authority/body (please specify)
Name:
Contact Details (Address / Email / Website)
On return of this questionnaire please include a copy of above-mentioned Standards (Preferably in English) Alternatively
provide a website address to access a copy of Standards.8. Appendix Two
ENSH Survey Table - European Smoking Cessation Training/Courses in 2006
Country:
Title
Tick the relevant Brief Intervention Training (Generic) 010 Smoking Cessation Training (Mental Health) 016
smoking cessation
training/course. Brief Intervention Training (Maternity) 011 Smoking Cessation Training (Drug abuse) 017
ONE SHEET
Brief Intervention Training (Mental Health) 012 Train the Trainers (Generic) 018
PER TRAINING
COURSE.
Brief Intervention Training (Drug abuse) 013 Train the Trainers (Maternity) 019
Smoking Cessation Training (Generic) 014 Train the Trainers (Mental Health) 020
Smoking Cessation Training (Maternity) 015 Train the Trainers (Drug abuse) 021
Other: 022
Duration
What is the length Half Day / Two Days 025
of the training /
course? Less than 4 hours 023 4-6 Days 026
Please tick.
Full Day / One Year 027
Less than 8 hours 024 Other 028
Type
What method of Formal training course with the hospital 029 University full-time training course 031
teaching/learning
is used? Formal training course with University E learning training course 032
Please tick.
the medical / nursing school 030 University distance learning training course 033
Other 034
Personnel
What hospital Medical – Consultant Hospital Doctors 035 Healthcare workers (non-professional) 039
personnel attend
the training / Medical – Non Consultant Hospital Doctors 036 Healthcare Professionals (ie Physiotherapist,
course?
Hospital Nurses 037 Occupational Therapists, etc) 041
Please tick.
Specialist Hospital Nurses 038 Other 0408. Appendix Two
ENSH Survey Table - European Smoking Cessation Training/Courses in 2006 (Cont)
Content
Which of the Epidemiology of Smoking and Alternative treatments / management
following are
included in the Smoking-Related Diseases 042 of relapses 046
core content of the
training / course?
Models of behaviour change 043 Motivational Interviewing techniques 047
Please tick
relevant box(s). National and International Role of health professional
guidelines and recommendations 044 in smoking cessation 048
Methods of coping with Managing / running a smoking
withdrawal symptoms 045 cessation group 049
Addiction, nicotine dependence and the use of Pharmacological treatments 050
National statistics and smoking cessation services in the National Health System/Quality control 051
Evaluation
How is the above Skills 052 Knowledge 053 Both 054
course evaluated?
Please tick.
Is the course
accredited to any YES 055 NO 056
professional body/
training body?
If YES, please state the course and corresponding awarding authority/bodyYou can also read
