Abstract:Background: In Malaysia, 21.3% of adults smoke, with Kedah reporting the highest prevalence at 27.6%. Brief interventions using the 5As framework (Ask, Advise, Assess, Assist, Arrange) can support cessation efforts through structured advice and timely referrals. Although healthcare providers have a strong role in delivering this intervention to patients in primary care settings, factors influencing implementation remain underexplored. This study aimed to measure healthcare providers’ practice of the brief intervention based on the 5As framework and identify associated factors, including self-efficacy, knowledge, and attitudes. Methods: A cross-sectional survey was conducted among 131 healthcare providers (doctors, nurses, pharmacists, and medical assistants) across eight primary care facilities in Kota Setar, Kedah, from February to April 2025. Data was collected using the validated FACTBIT tool, grounded in Social Cognitive Theory and the Theory of Planned Behaviour, via REDCap. Predictors included knowledge, self-efficacy, and attitudes. Analyses were conducted using Python 3, with statistical significance set at P<0.05. Results Of the 131 participants, 91.6% (95% CI: 85.6 95.6%) achieved good practice scores. Doctors and medical assistants (100%) scored higher than nurses (90.3%) and pharmacists (72.2%) (P=0.004). “Ask” (73.3%) and “Arrange” (68.7%) were most frequently practised, while “Assess” (56.5%) and “Assist” (41.2%) were less common. Self-efficacy was a strong predictor of practice (β=0.470, P<0.001), while pharmacists scored lower compared to other professions (β= 0.210, P=0.005). Knowledge (median=9/10, 67.9% <¥9) and attitudes (median=20/25) showed ceiling effects, limiting predictive value (P=0.593 and P=0.089, respectively). Conclusions Although overall practice in delivering brief smoking cessation interventions was high among primary care providers, the underutilisation of the “Assess” and “Assist” components indicates implementation gaps. Notably, pharmacists demonstrated lower performance compared to others, underscoring the need for targeted, role-specific interventions. Self-efficacy emerged as a key predictor, thus suggesting that training programs should prioritise building confidence in delivering cessation support to patients.
Keywords: Non-Communicable Diseases (NCDs), Tobacco cessation, 5As framework, self-efficacy, primary care, health workforce
