ArticleBMJ open2026
Translating knowledge gaps to practice: a knowledge, attitude and practice study based on 5A approach to improve smoking cessation training for healthcare providers in Karachi, Pakistan.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe 5A approach stands for chronological steps namely: Ask, Advise, Assess, Assist and Arrange that are recommended to healthcare providers (HCPs) for an effective smoking cessation counselling (SCC). This approach despite its effectiveness has not been evaluated in Pakistani healthcare settings. Understanding existing gaps in knowledge, attitudes and practices among HCPs is essential to inform targeted training interventions. Therefore, this study aimed to assess the knowledge, attitude and practice of HCPs regarding SCC, and to explore perceived barriers, facilitators and training needs related to its implementation.
designA cross-sectional study.
settingOne public and one private tertiary care teaching hospital in Karachi, Pakistan.
participants364 HCPs participated who were medical or dental practitioners working for at least past 6 months in Karachi, Pakistan. OUTCOME MEASURES: Knowledge, attitudes and practice scores related to SCC were the primary outcomes, while perceived barriers and facilitators and training needs were secondary outcomes.
resultsThe overall mean knowledge score was 16.8±4.8, indicating moderate knowledge levels. The mean attitude score was 5.7±1.58, reflecting generally favourable attitudes towards SCC, while the mean practice score was comparatively lower at 5.2±1.6, suggesting suboptimal implementation in routine practice. The most frequently reported barrier to delivering SCC was lack of patient willingness (64%), followed by limited access to cessation resources (52%). Improving patient health outcomes was the strongest motivator (64%), followed by a perceived professional responsibility (59%). Most HCPs reported that support from a multidisciplinary team (71.1%) and access to patient education materials (54.1%) would enhance SCC. Regarding training needs, behavioural counselling was the most requested (62.9%), followed by motivational interviewing (MI) (49.2%) and use of 5A approach (40.7%).
conclusionThis study highlights important gaps between knowledge, attitudes and practices related to SCC among HCPs in tertiary care settings. While attitudes towards smoking cessation are generally positive, limited practical application of the 5A approach persists, largely due to patient-related, structural and resource-based barriers. The findings underscore a need for structured, context-specific training programmes emphasising behavioural counselling, MI and practical application of the 5A framework. Strengthening institutional support, improving access to cessation resources and integrating smoking cessation training into routine clinical education may enhance the capacity of HCPs to translate knowledge into effective practice, ultimately improving patient quit outcomes.
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