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Mr. editor
We read with great interest this article by Tamirat T, which highlighted the surprisingly low engagement of health workers in smoking cessation interventions, in the Hadiya area.1 The World Health Organization (WHO) has declared smoking “the fastest-spreading and longest-lasting epidemic,” stressing the importance of an early and effective cessation intervention. However, although this relies heavily on good practices from healthcare workers, this document has shown that there is significant capacity for improvement, with only 3% of staff providing a satisfactory smoking cessation intervention.
This article highlights specific groups of health workers with lower rates of good practice in smoking cessation. We found the difference particularly striking between male and female participants, with men being 2.25 times more likely to engage in smoking cessation interventions. The author postulates that this is due to a difference in training, guidelines and obligations between the sexes.1 However, it can be argued that this is more correlated with the gender distribution of jobs, rather than with gender itself. 80.5% of doctors in southern Ethiopia are men and only 19.5% are women.2 In contrast, 67% of nurses are women and 33% are men.3 A study by Hasan et al, showed that nurses had less knowledge and self-efficacy about smoking cessation than doctors, which can be a barrier preventing them from discussing it with patients. The same study found that nurses showed the most improvement after receiving the proper training.4 Therefore, the disparity between male and female health workers may have a greater correspondence with the quality of training received by a particular role, rather than directly related to gender itself. These different roles could have been taken into account in the design of the study, allowing a better analysis of the results. Particularly relevant as more than 50% of the participants were nurses and 56.4% were women.
The article described the smoking status of healthcare workers as a factor contributing to their engagement and included it as a polar question in the questionnaire. However, this has not been further explored and discussed in regards to its effect on their weaning practice. Obtaining specific information like this in the form of a free text question would allow healthcare providers to detail distinct personal barriers or past experiences (such as cultural attitudes towards smoking) and give an overview of global attitudes towards smoking cessation.
In conclusion, this article has brought to the fore an indisputable and urgent problem in the Hadiya area. However, the study would have benefited from considering how multidimensional a variable such as gender is and incorporating that into the analysis. The inclusion of a free-text question would also have allowed for an in-depth analysis of the specific justifications behind the healthcare worker ‘s low engagement in smoking cessation interventions.
Disclosure
The authors do not point out any conflicts of interest in this communication.
The references
1. Tamirat T. Practice of health workers towards a smoking cessation intervention based on model 5A and associated factors in public hospitals, Hadiya zone, southern Ethiopia. Measuring patient outcomes. 2021; 12: 291-298. doi: 10.2147 / PROM.S322049
2. Assefa T, Haile Mariam D, Mekonnen W, Derbew M, Enbiale W. Distribution and attrition of physicians in the public health sector in Ethiopia. Risk management policy. 2016, 9: 285-295. doi: 10.2147 / RMHP.S117943
3. Fute M, Mengesha ZB, Wakgari N, Tessema GA. High prevalence of workplace violence among nurses working in public health facilities in southern Ethiopia. BMC Nurses. 2015, 14: 9. doi: 10.1186 / s12912-015-0062-1
4. Hasan SI, Mohd Hairi F, Ahmad Tajuddin NA, et al. Empowering health care providers through smoking cessation training in Malaysia: a pre-intervention and post-intervention assessment on improving knowledge, attitude and self-efficacy. BMJ Open. 2019; 9 (9): e030670. doi: 10.1136 / bmjopen-2019-030670
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