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.

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.

An Assessment of Enrollees' Knowledge and Satisfaction with Delta State Contributory Health Scheme: A Cross- Sectional Survey of Civil Servants in Delta State, Nigeria.

Background: Delta State Contributory Health Scheme (DSCHS) was established to provide quality and affordable healthcare services to all Deltans, irrespective of socioeconomic status and geographical location. This study assessed the knowledge and satisfaction of formal sector enrollees with the Delta State Contributory Health scheme. Methodology: This was a cross-sectional descriptive study involving 400 public/civil servants enrolled in DSCHS using a multistage sampling technique. Data was collected using an interviewer-administered structured questionnaire and was analyzed using IBM SPSS version 25.0 software. Results: The study revealed that 207 (51.7%) of the respondents were males, while 193 (48.3%) were females. Two hundred and five (51.2%) of the respondents were within the age group of 43 - 52 years, and 353 (88.2%) of the respondents had tertiary education. Overall, 296 (74.0%) of the respondents had good knowledge, and 104 (26.0%) had poor knowledge of DSCHS; while 138 (52.1%) of the respondents were unsatisfied with DSCHS and 127 (47.9%) were satisfied with the scheme. Age (X2 = 19.67; P<0.001), gender (X2 = 8.53; P=0.004), education (X2 = 20.52; P<0.001), marital status (X2 = 14.13; P=0.001), religion (X2 = 13.12; P=0.001) and years of working experience (X2 = 39.66; P<0.001) was significantly associated with knowledge of DSCHS. The factors significantly associated with satisfaction with DSCHS were ethnicity (X2 = 14.39; P=0.013) and years of working experience (X2 = 11.23; P=0.024). Conclusion: The majority of the study participants had good knowledge regarding DSCHS but were unsatisfied with the level of services provided by the scheme. It is therefore recommended that Delta State Contributory Health Commission should review its benefit package and urgently scale up services to improve enrollees' satisfaction with the scheme.