Nation-wide dissemination of a minimal contact smoking cessation intervention for general practitioners in the Netherlands: Predictors of GP'S adoption behaviour

An effective minimal contact smoking cessation program (MIS) for Dutch GPs was disseminated nation-wide, using a multi-component diffusion strategy. Two years after dissemination the MIS was implemented by 15.8% of Dutch GPs, increasing to 30% after four years. Objectives: To assess predictors of program implementation by GPs, determinants of adoption were observed in a prospective study. Methods: In a single group before-after design, involving a representative cohort of 297 GPs, determinants of MIS adoption were assessed: at baseline preceding dissemination and at one and two years follow-up. Organizational (i.e. number of years practising, practice type GP smoking) and social-cognitive variables were measured. Results: GPs starting practising after 1975 were more likely to implement the program (Odds R 4.6, p = 0.005). Other characteristics as age, not practising solo, and non-smoking, were found to be non-significant, but tended to predict MIS implementation (p<0.10). GPs believing at baseline that anti-smoking counseling effectively promotes cessation, belongs to their preventive tasks, provides a major health gain, and is not paternalistic towards patients, were more likely to implement MIS. Self-efficacy was not predictive of adoption at baseline, but did explain MIS usage at follow-up. In subjective norm, a shift was observed from proximal referents (office personell, colleagues) being influential at baseline, to patients at first follow-up, to distal referents (regional and national organisations) at second follow-up. Conclusions: Given the fact that in the Netherlands a fee for smoking cessation counseling and reimbursement of nicotine replacement therapy are lacking, the 30% implementation rate of the MIS may be considered as a positive outcome. The longitudinal analysis of adoption determinants revealed useful insight into the social-cognitive changes that take place during such an innovation process.