Tobacco cessation skills certification in Arizona: Application of a state wide, community based model for diffusion of evidence based practice guidelines

Objective - To describe the development and preliminary results from a community based certification model for training in tobacco cessation skills in Arizona. Design - A programme evaluation using both quantitative pre-post measures and qualitative methods. Setting - Arizona's comprehensive tobacco control programme of state funded, community based local-projects and their community partners providing tobacco treatment services for geographically, socioeconomically, and ethnically diverse communities. Intervention - A three tiered model of skills based training emphasising Agency for Health Care Policy and Research guidelines, and utilising a training of trainers approach to build community capacity. Certification roles addressed basic tobacco cessation skills, tobacco cessation specialist, and tobacco treatment services manager. Participants - Initial target audience was community based local project personnel and their community partners, with later adoption by community organisations unaffiliated with local projects, and the general public. Main evaluation measures - Process measures: participant satisfaction, knowledge, skills, and self-efficacy. Outcome: participant demographics, community organisations represented, post-training, cessation related activities. Results - During the model's implementation year, 1075 participants attended certification training, 947 participants received basic skills certificates and 82 received specialist certificates. Pre, post, and three month measures of self efficacy showed significant and durable increases. Analysis of participant characteristics demonstrated broad community representation. At post-training follow up, 80.9% of basic skills trainees had performed at least one brief intervention and 74.8% had made a referral to intensive services. Among cessation specialists, 48.8% were delivering intensive services and 69.5% were teaching basic skills classes. Conclusions - Initial experience with Arizona's state wide, community based model for certification of tobacco cessation skills training suggests this model may be a promising method for broad, population based diffusion of evidence based tobacco cessation guidelines.