Pre/post Survey Measuring Self-reported Physician Behavior, Attitudes, Comfort, and Knowledge
| 1. How would you describe your hand-held computer literacy? | ||||||
| a. Novice | b. Intermediate | c. Expert | ||||
| 2. What percentage of your patients smoke? (Please check one) | ||||||
| □ <10% | □ 10% | □ 20% | □ 30% | □ 40% | ||
| □ 50% | □ 60% | □ 70% | □ 80% | □ 90% | □ >90% | |
| 3. How often do you: | ||||||
| a. Ask patients if they smoke? | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| b. Advise smokers to quit? | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| c. Assess smokers’ willingness to quit? | ||||||
| □ Never | □ Sometimes | □ Often | □Always | |||
| d. Assist smokers in their attempt to quit? | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| e. Arrange follow-up with patients who want to quit? | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| 4. How often do you: | ||||||
| a. Provide counseling for patients who want to quit smoking? | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| b. Have sufficient time available with smoking patients to counsel them on initiating and sustaining a smoking cessation plan? | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| c. Provide information on quitting such as pamphlets, videos, or online resources | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| d. Recommend pharmacotherapy for your patients who want to quit? | ||||||
| □ Never | □ Sometimes | □ Often | □ Always | |||
| 5. If you recommend pharmacotherapy, what do you recommend? (Check all that apply) | ||||||
| □ Nicotine Patch | □ Patch | □ Inhaler | □ Nasal spray | |||
| □ Bupropion (Wellbutrin/Zyban) | ||||||
| 6. I have a specific intervention plan(s) I use with patients who want to quit smoking. | ||||||
| □ Yes | □ No | |||||
| 7. Are you familiar with the Public Health Service Clinical Practice Guidelines on smoking cessation? | ||||||
| □ Yes | □ No | |||||
| 8. The importance I place on identifying patients who smoke is | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Very unimportant | Very important | |||||
| 9. The importance I place on counseling patients who smoke is | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Very unimportant | Very important | |||||
| 10. How comfortable are you counseling patients about smoking cessation? | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Very uncomfortable | Very comfortable | |||||
| 11. How comfortable are you with the Public Health Service Clinical Practice Guidelines? | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Very uncomfortable | Very comfortable | |||||
| 12. What is your comfort level with the pharmacological therapies available to aid smokers with quitting smoking? | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Very uncomfortable | Very comfortable | |||||
| 13. How comfortable are you following patients who have initiated a smoking cessation plan to help them sustain their plan? | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Very uncomfortable | Very comfortable | |||||
| 14. My comfort level counseling patients about smoking cessation was enhanced by using the HCSIT. | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Strongly disagree | Strongly agree | |||||
| 15. My comfort level with pharmacological therapies available to aid smokers with quitting smoking was enhanced by using the HCSIT. | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Strongly disagree | Strongly agree | |||||
| 16. My comfort level with the Public Health Service Clinical Practice Guidelines was enhanced by using the HCSIT. | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Strongly disagree | Strongly agree | |||||
| The following questions apply to the HCSIT: | ||||||
| 17. I found the HCSIT tool easy to use. | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Strongly disagree | Strongly agree | |||||
| 18. I liked the way the HCSIT tool was organized on the hand held computer. | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Strongly disagree | Strongly agree | |||||
| 19. I found the HCSIT tool easy to understand. | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Strongly disagree | Strongly agree | |||||
| 20. The HCSIT tool was fast enough to use/access in the clinical encounter. | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Strongly disagree | Strongly agree |
HSCIT, hand-held smoking cessation intervention tool.