Robin Newhouse, PhD, RN, NEA-BC, FAAN University of Maryland School of Nursing

The Smoking Cessation Counseling Scale (SCC): Psychometrics and Application

to Research and Practice

Robin Newhouse, PhD, RN, NEA-BC, FAAN

University of Maryland School of Nursing

This study was funded by a grant from the Robert Wood Johnson Foundation

Study Team

*Robin Newhouse, PhD, RN

Laura Morlock, PhD

*Cheryl Dennison, PhD, RN

Kevin Frick, PhD

Peter Pronovost, MD, PhD

*Yulan Liang, PhD

RAs: Janine Michaelson, RN, BSN & Julie Twigg RN, BSN

2* Co-presenters

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Aims of Study

Parent study

A phased randomized cluster trial to evaluate the effect of a rural hospital collaborative on HF patient care

Sub-study

Test the psychometric properties of the Smoking Cessation Counseling Scale (SCC) which measures evidence-based smoking cessation practices

Helping Smokers Quit: A Guide for Nurses. March 2005. Agency for Healthcare Research and Quality, Rockville, MD.

Available at: http://www.nurses4tobaccocontrol.org/files/AHRQnursesGuide.pdf

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Design and Sample

Design: Cross-sectional

Sample: 23 rural hospitals from the eastern U.S.

591 Registered Nurses

Data source: Written survey (SCC) at baseline

Nurse Demographics

Characteristic N Percentage

Full Time 499 84.4%

Age 36-50 243 41.1%

18-35 209 35.4%

51-65 126 21.3%

Race White 522 88.3%

Gender Female 554 93.7%

Degree Associates

338 57.2%

Bachelors Degree 189 32.0%

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Hospital Demographics

Characteristic Mean(SD) Range

Hospital Beds 131 (95) 20-390

Average Daily Census 80 (70) 7-323

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SCC Description

24 items with response format:

1= not at all2= less than ½ of the time,3= more than ½ of the time and 4= all of the time

2 items with response format:

10 point (1-not at all to 10- very)

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 Advanced Counseling Means(SD) FL*

I advise smokers to set a quit date 2.44(1.06) .59

I advise smokers to get support from family, friends and coworkers 2.95(0.94) .69

I review past quit attempts-what helped, what led to relapse 2.45 (0.98) .71

I help the patient anticipate challenges, particularly during the critical first few weeks 2.54 (0.96) .77

I help patients anticipate nicotine withdraw 2.77(0.97) .78

I identify reasons for quitting and benefits of quitting 3.19(0.85) .66

I advise patients that total abstinence is essential-not even a single puff 2.65(1.07) .74

I advise patients that drinking alcohol is strongly associated with relapse 2.35 (1.06) .69

I advise patients that having other smokers in household hinders successful quitting 2.87(1.02) .78

I recommend use of over-the-counter nicotine patch, gum or lozenge; or get a prescription for nasal spray, inhaler, or buproprion SR unless contraindicated

2.97(0.96) .62

I use cessation materials that are appropriate by age, culture, language, education and pregnancy status

2.64(1.04) .48

I provide information for follow-up visits with the patient's doctor 2.46(1.10) .45

I advise patients if relapse occurs, they should repeat the quit attempt-it is part of the quitting process

2.58(1.04) .80

I advise patients if relapse occurs, they should review the circumstances and learn from the experience

2.54(1.05) .82

I advise patients that if relapse occurs, they should reassess the pharmacotherapy use and problems

2.36(1.04) .77

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Referral to Services Means(SD) FL*

I provide the number for the toll-free National Quitline 2.19(1.09) .72

I refer the patient to web resources for AHRQ 1.95(1.00) .86

I refer the patient to web resources for Tobacco Free Nurses Initiative 1.77(0.93) .86

10FL*= Factor Loadings

Basic Counseling Means(SD) FL*

I advise tobacco users to quit 3.46(0.79) .71

I ask tobacco users if they are willing to quit 3.30(0.86) .69

If tobacco users are willing to quit, I provide resources and assistance 3.60(0.64) .67

If tobacco users are not willing to quit, I provide resources and help patient identify barriers to quitting

3.05(0.93) .62

Standard Care Means(SD) FL*

I assess my patient tobacco use 3.6(0.61) .86

I document my patient tobacco use 3.5(0.67) .85

Convergent Validity

Total SCC was positively associated with comfort in smoking cessation counseling (r=.604, p<.000) and comfort in referral to resources (r=.630, p<.000).

When controlling for age, gender, work status, education and ethnicity, comfort with smoking cessation counseling independently predicted higher total SCC scores, explaining 36% of variance in SCC (adjusted R2 =0.36).

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Psychometrics

Reliability:

Cronbach’s alpha = 0.955

Validity:

Exploratory Factor Analysis: All items loaded on four factors (explained 68.3% of SCC variation)

Convergent validity: Controlling for nurse characteristics, comfort in smoking cessation counseling predict higher SCC scores (R2 = 0.36)

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Newhouse, R., Dennison, C., Liang, Y. Psychometric Testing of the Smoking Cessation Counseling (SCC) Scale. (2011). Journal of Nursing Scholarship, 43(4), 405-11 doi 10.1111/j.1547-5069.2011.01420.x.

Newhouse, R.P., Dennison, C, Liang, Y., Morlock, L., Frick, K., Pronovost, P. (2011). Smoking Cessation Counseling by Registered Nurses: Description and Predictors in Rural Hospitals. American Nurse Today Online, 6(6). Available at: http://www.americannursetoday.com/Article.aspx?id=7902&fid=7870.

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References

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Robin P. Newhouse, PhD, RN

[email protected]

410-706-7654