A 12-month longitudinal outcomes and process evaluation of the adapted Certified Tobacco Treatment Specialist (aCTTS) program for physicians in the Former Yugoslav Republic of Macedonia (FYROM)
Bibliographic record
Abstract
Introduction A Certified Tobacco Treatment Specialist (CTTS) program was adapted to address socio-cultural contexts of tobacco use in FYROM. The training objectives were to increase provider knowledge regarding tobacco use and risks; increase provider self-efficacy for patient counseling; decrease tobacco use among providers; and document provider counseling during post-intervention clinic appointments. Methods A survey was conducted at baseline, and 6- and 12-months post-intervention. Bivariate and multivariate analyses were conducted to determine significant changes across time and refine associations between independent and dependent variables. Weekly logbook data documented numbers of patients counseled and time spent counseling. Results Of 97 participants who completed baseline, 72 (74.2%) completed the 12-month survey. Scores on a 30-item knowledge scale increased between baseline (10.5), 6-month (18.9) and 12-month (20.7) post-intervention (p<0.001). Between baseline and 12 months, perceived barriers to engaging with patients regarding tobacco use decreased (p=0.001) and confidence in providing tobacco treatment counseling increased (p=0.046). At baseline and 12-month post-intervention respectively, 29% and 20% of respondents reported current smoking (p<.001). Providers’ interest or engagement in quitting tobacco increased significantly between baseline and 6-month (p=0.026) and 12-month (p=0.019) post-intervention. Logbook data indicate that 39% of patient visits were tobacco related with 78% of those patients receiving counseling. Conclusion There is an urgent need for tobacco-focused education among health providers in FYROM. The adapted CTTS program was well-received. Data indicate physicians are engaging in tobacco counseling, with increased knowledge and greater confidence. Future efforts include expanding training in FYROM and possibly elsewhere in the Balkan region.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".