1
|
Gupta PC, Narake S, Sinha DN, Nagler E, Pednekar MS, Sorensen G. Upscaling a behavioural intervention program for tobacco use cessation - A randomised controlled study. Prev Med Rep 2023; 36:102476. [PMID: 37908199 PMCID: PMC10613902 DOI: 10.1016/j.pmedr.2023.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023] Open
Abstract
A randomised control trial was conducted among school teachers in Bihar, India for upscaling a tested, evidence-based tobacco intervention using train-the-trainer model. Six blocks in three districts were selected and randomised into intervention and control blocks. Cluster coordinators in intervention blocks were given training in the details of intervention. Cluster coordinators routinely train headmasters and they were asked to include intervention training in their routine. Except for the training material, no additional resources were provided to cluster coordinators and headmasters. Headmasters implemented the intervention along with the teachers in the school. Post-intervention random sample of 70 schools out of 219 schools from intervention blocks and 70 schools out of 224 schools in control blocks were surveyed. The survey was self-administered among 429 school teachers in intervention schools and 331 among control schools. For all 140 headmasters, the survey was interviewer administered. Almost all headmasters in intervention schools had attended the training and had involved teachers in the intervention program. Odds ratios for carrying out the recommended activities in intervention schools compared to control schools were very high and significant. In addition, intervention schools also conducted activities such as including intervention messages in classroom teaching and conveying them to parents, activities that were not directly recommended in intervention program. Thus, this train-the-trainer model demonstrated that it is possible to upscale the intervention programs successfully with the resources within the system.
Collapse
Affiliation(s)
| | | | | | - Eve Nagler
- Center for Community-Based Research, Dana-Farber Cancer Institute, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | | | - Glorian Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| |
Collapse
|
2
|
Sklar RP, Goldman RE. "The First Person They Call is Their Pastor": The Role of New York City Faith Leaders in Supporting Their Congregation's Health and Well-Being During COVID-19. JOURNAL OF RELIGION AND HEALTH 2023:1-20. [PMID: 36917363 PMCID: PMC10011784 DOI: 10.1007/s10943-023-01789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
This article reports findings from a qualitative study of New York City faith leaders' efforts to mitigate the effects of the COVID-19 pandemic on their communities during the first two years of the pandemic. Faith leaders were recruited via reputational case sampling to participate in individual, key informant interviews. This study used a social-contextual approach to health promotion by exploring the influence of faith leaders and religious communities on health behaviors. Results suggest that engaged faith leaders worked individually and collaboratively to support the changing physical, emotional, and spiritual needs of their religious communities and those in the surrounding area. This study highlights the importance of faith leaders as supporters, communicators, and advocates, and provides directions for future research on the impact of faith leaders on individuals' experiences and health behaviors during a pandemic.
Collapse
Affiliation(s)
- Rachel P Sklar
- Division of Biology and Medicine, Brown University, Providence, RI, USA.
| | | |
Collapse
|
3
|
Gakkhar A, Mehendale A, Mehendale S. Tobacco Cessation Intervention for Young People. Cureus 2022; 14:e30308. [PMID: 36407239 PMCID: PMC9659423 DOI: 10.7759/cureus.30308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023] Open
Abstract
Most adolescent tobacco control programs focus on preventing consumption, but teen smoking persists. It is uncertain whether adult-specific therapies can assist adolescents in quitting smoking. The rising incidence of smoking in low and middle-socioeconomic countries and the challenges of conducting tobacco cessation programs in these settings (due to increasing population, poor lifestyle, lack of awareness and education, professional stress, and non-compliance) need an emphasis on the scope of trials to conduct tobacco cessation in these settings. In the 11th Five Year Plan, the Indian government introduced a new National Tobacco Control Program, which currently spans 108 districts in 31 states across the country. The objective is to review the randomized control trials of selected individuals held in India and assess and evaluate the effectiveness of the steps taken by the government to help people quit tobacco consumption. These programs are important because of the hazards and impact they have on the public health indices of the nation. The government has taken steps like prohibiting smoking in public areas and banning sources. Several programs, particularly those that employed group counselling, included a range of approaches that proved beneficial in helping young people quit smoking. The RCTs mentioned are psychosocially followed by behavioral and pharmacological therapies. The challenges faced are not having participatory health care, motivating tobacco users to quit even in the short-term, adequate coverage; barriers at a different level of implementation (at a regional, state, or national level); and interference by the tobacco industry should be eliminated. The currently functioning programs in India are the National Tobacco Control Program, the National and three Regional Quitlines and mCessation.
Collapse
Affiliation(s)
- Avni Gakkhar
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ashok Mehendale
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shivansh Mehendale
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Insititute of Medical Sciences, Wardha, IND
| |
Collapse
|
4
|
Wolfenden L, McCrabb S, Barnes C, O'Brien KM, Ng KW, Nathan NK, Sutherland R, Hodder RK, Tzelepis F, Nolan E, Williams CM, Yoong SL. Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database Syst Rev 2022; 8:CD011677. [PMID: 36036664 PMCID: PMC9422950 DOI: 10.1002/14651858.cd011677.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions. OBJECTIVES 1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review. SELECTION CRITERIA We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines. MAIN RESULTS We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review. AUTHORS' CONCLUSIONS The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
Collapse
Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kate M O'Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kwok W Ng
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensu, Finland
| | - Nicole K Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rebecca K Hodder
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Erin Nolan
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Musculoskeletal Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| |
Collapse
|
5
|
Shankar D, Borrelli B, Cobb V, Quintiliani LM, Palfai T, Weinstein Z, Bulekova K, Kathuria H. Text-messaging to promote smoking cessation among individuals with opioid use disorder: quantitative and qualitative evaluation. BMC Public Health 2022; 22:668. [PMID: 35387648 PMCID: PMC8988312 DOI: 10.1186/s12889-022-13008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Individuals with opioid use disorder (OUD) who smoke cigarettes have high tobacco-related comorbidities, lack of access to tobacco treatment, lack of inclusion in smoking cessation trials, and remain understudied in the mobile health field. The purpose of this study was to understand patients' with OUD perceptions of 1) text message programs to promote smoking cessation, 2) content and features to include in such a program, and 3) how message content should be framed. METHODS From December 2018 to February 2019, we recruited 20 hospitalized individuals with a concurrent diagnosis of OUD and tobacco dependence at Boston Medical Center (BMC), the largest safety-net hospital in New England. We surveyed participants' cell phone use, their interest in a text message program to promote smoking cessation, and their reactions to and ratings of a series of 26 prototype texts. We then conducted open-ended interviews to elicit content and suggestions on how text message interventions can improve motivation to increase smoking cessation among individuals with OUD. The interviews also included open-ended inquiries exploring message ratings and message content, inquiries about preferences for message duration, frequency, and personalization. RESULTS Quantitative analysis of questionnaire data indicated that the majority of participants owned a cell phone (95%, 19/20). Most participants (60%, 12/20) reported that they would be interested or very interested in receiving text messages about smoking cessation. Text messages about the health benefits of quitting were rated the highest among various categories of text messages. Qualitative analysis showed that almost every participant felt that text messages would help motivate smoking cessation given the support it would provide. CONCLUSIONS This study demonstrates that individuals with OUD who smoke cigarettes perceive that a text message program designed to promote smoking cessation would motivate and support smoking cessation efforts. Our findings demonstrate that such a program is feasible as participants own cell phones, frequently send and receive text messages, and have unlimited text message plans. Findings from this study provide valuable insight into content and features to include when developing text message programs to address barriers to smoking cessation in individuals who have OUD and smoke cigarettes.
Collapse
Affiliation(s)
- Divya Shankar
- Pulmonary Center, Department of Medicine, Boston University Medical Center, 72 East Concord Street, R304, Boston, MA, USA.
| | - Belinda Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Vinson Cobb
- Pulmonary Center, Department of Medicine, Boston University Medical Center, 72 East Concord Street, R304, Boston, MA, USA
| | - Lisa M Quintiliani
- Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Tibor Palfai
- Psychological and Brain Science, Boston University, Boston, MA, USA
| | - Zoe Weinstein
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Katia Bulekova
- Research Computing Services (RCS) group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Hasmeena Kathuria
- Pulmonary Center, Department of Medicine, Boston University Medical Center, 72 East Concord Street, R304, Boston, MA, USA
| |
Collapse
|
6
|
Portilla A, Meza MF, Lizana PA. Association between Emotional Exhaustion and Tobacco Consumption in Teachers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052606. [PMID: 35270298 PMCID: PMC8909664 DOI: 10.3390/ijerph19052606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 12/30/2022]
Abstract
Teachers have been reported as having high levels of emotional exhaustion (EE). It has also been observed that tobacco consumption (TC) is higher during stressful events. However, there is little evidence about the association between EE and TC among teachers. A total of n = 560 teachers took part in this study, where 71.79% (n = 402) were women. For data gathering, the EE dimension of the Maslach Inventory for teachers was used, along with a TC questionnaire and the sociodemographic data of the participants. A binary logistical regression model was used for statistical analysis. Regarding TC, over 30% of teachers declared that they smoked; 65% of the teachers presented medium-high EE and 31% of teachers presented high EE. Teachers who said they were smokers had a greater risk of presenting high EE (OR: 1.7, p < 0.05), along with younger teachers (≤44 years; OR: 2.1, p < 0.01). In addition, teachers with high EE also have a high risk of TC. The present study reports an association between TC and high EE category among teachers, regardless of gender. An important association is also observed between the under-45 age group and high EE. These results indicate that teachers should have psychological support and interventions aiding them with facing work stress and TC habits, especially for younger teachers.
Collapse
Affiliation(s)
- Alexis Portilla
- Laboratory of Epidemiology and Morphological Sciences, Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Valparaíso 2373223, Chile; (A.P.); (M.F.M.)
- Programa de Magíster en Didáctica de las Ciencias Experimentales; Facultad de Ciencias, Pontificia Universidad Católica de Valparaíso, Valparaíso 2373223, Chile
| | - María Fernanda Meza
- Laboratory of Epidemiology and Morphological Sciences, Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Valparaíso 2373223, Chile; (A.P.); (M.F.M.)
| | - Pablo A. Lizana
- Laboratory of Epidemiology and Morphological Sciences, Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Valparaíso 2373223, Chile; (A.P.); (M.F.M.)
- Correspondence:
| |
Collapse
|
7
|
Nagler EM, Stelson EA, Karapanos M, Burke L, Wallace LM, Peters SE, Nielsen K, Sorensen G. Using Total Worker Health ® Implementation Guidelines to Design an Organizational Intervention for Low-Wage Food Service Workers: The Workplace Organizational Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9383. [PMID: 34501975 PMCID: PMC8430617 DOI: 10.3390/ijerph18179383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023]
Abstract
Total Worker Health® (TWH) interventions that utilize integrated approaches to advance worker safety, health, and well-being can be challenging to design and implement in practice. This may be especially true for the food service industry, characterized by high levels of injury and turnover. This paper illustrates how we used TWH Implementation Guidelines to develop and implement an organizational intervention to improve pain, injury, and well-being among low-wage food service workers. We used the Guidelines to develop the intervention in two main ways: first, we used the six key characteristics of an integrated approach (leadership commitment; participation; positive working conditions; collaborative strategies; adherence; data-driven change) to create the foundation of the intervention; second, we used the four stages to guide integrated intervention planning. For each stage (engaging collaborators; planning; implementing; evaluating for improvement), the Guidelines provided a flexible and iterative process to plan the intervention to improve safety and ergonomics, work intensity, and job enrichment. This paper provides a real-world example of how the Guidelines can be used to develop a complex TWH intervention for food service workers that is responsive to organizational context and addresses targeted working conditions. Application of the Guidelines is likely transferable to other industries.
Collapse
Affiliation(s)
- Eve M. Nagler
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (E.A.S.); (M.K.); (L.B.); (L.M.W.); (S.E.P.); (G.S.)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Elisabeth A. Stelson
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (E.A.S.); (M.K.); (L.B.); (L.M.W.); (S.E.P.); (G.S.)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Melissa Karapanos
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (E.A.S.); (M.K.); (L.B.); (L.M.W.); (S.E.P.); (G.S.)
| | - Lisa Burke
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (E.A.S.); (M.K.); (L.B.); (L.M.W.); (S.E.P.); (G.S.)
| | - Lorraine M. Wallace
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (E.A.S.); (M.K.); (L.B.); (L.M.W.); (S.E.P.); (G.S.)
| | - Susan E. Peters
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (E.A.S.); (M.K.); (L.B.); (L.M.W.); (S.E.P.); (G.S.)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Karina Nielsen
- Institute of Work Psychology, Sheffield University Management School, University of Sheffield, Sheffield S10 1FL, UK;
| | - Glorian Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (E.A.S.); (M.K.); (L.B.); (L.M.W.); (S.E.P.); (G.S.)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| |
Collapse
|
8
|
Brakema EA, van der Kleij RM, Poot CC, Chavannes NH, Tsiligianni I, Walusimbi S, An PL, Sooronbaev T, Numans ME, Crone MR, Reis RR. A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries. BMJ Glob Health 2021; 6:bmjgh-2020-003221. [PMID: 33436446 PMCID: PMC7805378 DOI: 10.1136/bmjgh-2020-003221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/06/2020] [Accepted: 11/27/2020] [Indexed: 01/18/2023] Open
Abstract
Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps: (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders. Use of the tool proved highly feasible, acceptable and effective in each setting. To conclude, the SETTING-tool is validated to systematically map local contexts for (lung) health interventions in diverse low-resource settings. It can support policy-makers, non-governmental organisations and health workers in the design of context-driven implementation strategies. This can reduce the risk of implementation failure and the waste of resource potential. Ultimately, this could improve health outcomes.
Collapse
Affiliation(s)
- Evelyn A Brakema
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Charlotte C Poot
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraclion, Crete, Greece
| | - Simon Walusimbi
- Department of Medicine and Makerere Lung Institute, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Pham Le An
- Center of Training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Talant Sooronbaev
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Matty R Crone
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria R Reis
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,The Children's Institute, University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
9
|
Ensuring Organization-Intervention Fit for a Participatory Organizational Intervention to Improve Food Service Workers' Health and Wellbeing: Workplace Organizational Health Study. J Occup Environ Med 2021; 62:e33-e45. [PMID: 31815814 DOI: 10.1097/jom.0000000000001792] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Food-service workers' health and wellbeing is impacted by their jobs and work environments. Formative research methods were used to explore working conditions impacting workers' health to inform intervention planning and implementation and to enhance the intervention's "fit" to the organization. METHODS Four qualitative methods (worker focus groups; manager interviews; worksite observations; multi-stakeholder workshop) explored in-depth and then prioritized working conditions impacting workers' health as targets for an intervention. RESULTS Prioritized working conditions included: ergonomics; work intensity; career development; and job enrichment. Data revealed necessary intervention mechanisms to enhance intervention implementation: worker and management communication infrastructure; employee participation in intervention planning and implementation; tailored worksite strategies; and ensuring leadership commitment. CONCLUSIONS These targeted, comprehensive methods move away from a typical focus on generic working conditions, for example, job demands and physical work environment, to explore those conditions unique to an organization. Thereby, enhancing "intervention-fit" at multiple levels within the company context.
Collapse
|
10
|
Implementing a context-driven awareness programme addressing household air pollution and tobacco: a FRESH AIR study. NPJ Prim Care Respir Med 2020; 30:42. [PMID: 33024125 PMCID: PMC7538921 DOI: 10.1038/s41533-020-00201-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Most patients with chronic respiratory disease live in low-resource settings, where evidence is scarcest. In Kyrgyzstan and Vietnam, we studied the implementation of a Ugandan programme empowering communities to take action against biomass and tobacco smoke. Together with local stakeholders, we co-created a train-the-trainer implementation design and integrated the programme into existing local health infrastructures. Feasibility and acceptability, evaluated by the modified Conceptual Framework for Implementation Fidelity, were high: we reached ~15,000 Kyrgyz and ~10,000 Vietnamese citizens within budget (~€11,000/country). The right engaged stakeholders, high compatibility with local contexts and flexibility facilitated programme success. Scores on lung health awareness questionnaires increased significantly to an excellent level among all target groups. Behaviour change was moderately successful in Vietnam and highly successful in Kyrgyzstan. We conclude that contextualising the awareness programme to diverse low-resource settings can be feasible, acceptable and effective, and increase its sustainability. This paper provides guidance to translate lung health interventions to new contexts globally.
Collapse
|
11
|
Brakema EA, Vermond D, Pinnock H, Lionis C, Kirenga B, An PL, Sooronbaev T, Chavannes NH, van der Kleij MJJR. Implementing lung health interventions in low- and middle-income countries: a FRESH AIR systematic review and meta-synthesis. Eur Respir J 2020; 56:13993003.00127-2020. [PMID: 32341109 PMCID: PMC7409813 DOI: 10.1183/13993003.00127-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/29/2020] [Indexed: 01/17/2023]
Abstract
The vast majority of patients with chronic respiratory disease live in low- and middle-income countries (LMICs). Paradoxically, relevant interventions often fail to be effective particularly in these settings, as LMICs lack solid evidence on how to implement interventions successfully. Therefore, we aimed to identify factors critical to the implementation of lung health interventions in LMICs, and weigh their level of evidence. This systematic review followed Cochrane methodology and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting standards. We searched eight databases without date or language restrictions in July 2019, and included all relevant original, peer-reviewed articles. Two researchers independently selected articles, critically appraised them (using Critical Appraisal Skills Programme (CASP)/Meta Quality Appraisal Tool (MetaQAT)), extracted data, coded factors (following the Consolidated Framework for Implementation Research (CFIR)), and assigned levels of confidence in the factors (via Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual)). We meta-synthesised levels of evidence of the factors based on their frequency and the assigned level of confidence (PROSPERO:CRD42018088687). We included 37 articles out of 9111 screened. Studies were performed across the globe in a broad range of settings. Factors identified with a high level of evidence were: 1) “Understanding needs of local users”; 2) ensuring “Compatibility” of interventions with local contexts (cultures, infrastructures); 3) identifying influential stakeholders and applying “Engagement” strategies; 4) ensuring adequate “Access to knowledge and information”; and 5) addressing “Resource availability”. All implementation factors and their level of evidence were synthesised in an implementation tool. To conclude, this study identified implementation factors for lung health interventions in LMICs, weighed their level of evidence, and integrated the results into an implementation tool for practice. Policymakers, non-governmental organisations, practitioners, and researchers may use this FRESH AIR (Free Respiratory Evaluation and Smoke-exposure reduction by primary Health cAre Integrated gRoups) Implementation tool to develop evidence-based implementation strategies for related interventions. This could increase interventions’ implementation success, thereby optimising the use of already-scarce resources and improving health outcomes. This systematic review and meta-synthesis shows why implementation of lung health interventions often fails in low- and middle-income countries, and it provides critical factors to prevent failure with their level of evidencehttps://bit.ly/2UYJOSa
Collapse
Affiliation(s)
- Evelyn A Brakema
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Debbie Vermond
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Bruce Kirenga
- Dept of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Pham Le An
- Center of Training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Talant Sooronbaev
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Niels H Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | | |
Collapse
|
12
|
Nagler EM, Aghi M, Rathore A, Lando H, Pednekar MS, Gupta PC, Stoddard AM, Kenwood C, Penningroth B, Sinha DN, Sorensen G. Factors associated with successful tobacco use cessation among teachers in Bihar state, India: a mixed-method study. HEALTH EDUCATION RESEARCH 2020; 35:60-73. [PMID: 31999824 PMCID: PMC6991618 DOI: 10.1093/her/cyz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
Although tobacco use is declining in several countries including India (dropping from 35% in 2009-10 to 29% 2016-17 among adults)-it still poses a huge burden on India, as the world's second largest consumer of tobacco products. In Bihar state, with a prevalence of 25%, the Bihar School Teachers Study (BSTS) successfully enlisted teachers as role models for encouraging quitting and changing social norms pertaining to tobacco. The study used a mixed-methods approach to identify factors associated with teachers' quitting. Qualitative data were collected through focus groups with teachers and school principals. Quantitative data were collected through a written survey administered to school personnel post-intervention. Key findings from focus groups were that teachers and principals quit using tobacco and promoted cessation because they wanted to model positive behaviors; specific information about tobacco's harms aided cessation; and the BSTS intervention facilitated a school environment that supported quitting. Survey results indicated teachers who reported knowing people who quit using tobacco in the prior year were far more likely to quit as were teachers who reported that their school's tobacco policy was completely enforced. The combination of qualitative and quantitative data yielded important insights with strong implications for future interventions.
Collapse
Affiliation(s)
- E M Nagler
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, 450 Brookline Avenue, LW722 Boston, MA 02115, USA
| | - M Aghi
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - A Rathore
- Welobaby Jaipur, Rajasthan 302039, India
| | - H Lando
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
| | - M S Pednekar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - P C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - A M Stoddard
- Biostatistical Consultant, Pelham, MA 01002, USA
| | - C Kenwood
- Veristat, LLC, Southborough, MA 01772, USA
| | | | - D N Sinha
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - G Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, 450 Brookline Avenue, LW722 Boston, MA 02115, USA
| |
Collapse
|
13
|
Wolfenden L, Nathan NK, Sutherland R, Yoong SL, Hodder RK, Wyse RJ, Delaney T, Grady A, Fielding A, Tzelepis F, Clinton‐McHarg T, Parmenter B, Butler P, Wiggers J, Bauman A, Milat A, Booth D, Williams CM. Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease. Cochrane Database Syst Rev 2017; 11:CD011677. [PMID: 29185627 PMCID: PMC6486103 DOI: 10.1002/14651858.cd011677.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. OBJECTIVES The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. SEARCH METHODS All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research. SELECTION CRITERIA 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review. AUTHORS' CONCLUSIONS Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
Collapse
|
14
|
Spadola CE, Rottapel R, Khandpur N, Kontos E, Bertisch SM, Johnson DA, Quante M, Khalsa SBS, Saper RB, Redline S. Enhancing yoga participation: A qualitative investigation of barriers and facilitators to yoga among predominantly racial/ethnic minority, low-income adults. Complement Ther Clin Pract 2017; 29:97-104. [PMID: 29122272 DOI: 10.1016/j.ctcp.2017.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/26/2022]
Abstract
Yoga is underutilized among racial/ethnic minorities and low-income populations. To enhance participation among these demographic groups and to inform a future clinical trial, we conducted a qualitative formative investigation, informed by the Social Contextual Model of health behavior change, to identify barriers and facilitators to yoga that could impact study participation. We recruited twenty-four racially/ethnically diverse adults, with and without prior yoga experience, from a low-income, urban housing community to participate in either an individual interview or focus group. A thematic data analysis approach was employed. Barriers to yoga engagement included the perception that yoga lacks physicality and weight loss benefits, fear of injury, lack of ability/self-efficacy to perform the practices, preference for other physical activities, and scheduling difficulties. Facilitators of yoga engagement included a quality yoga instructor who provides individualized instruction, beginner level classes, and promotional messaging that highlights the potential benefits of yoga, such as stress reduction.
Collapse
Affiliation(s)
- Christine E Spadola
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States.
| | - Rebecca Rottapel
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States
| | - Neha Khandpur
- Department of Nutrition, Faculty of Public Health, University of Sao Paulo, Brazil
| | - Emily Kontos
- DynaMed, EBSCO Health, Ipswich, MA, United States
| | - Suzanne M Bertisch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, United States
| | - Dayna A Johnson
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Mirja Quante
- Department of Neonatology, University of Tuebingen, Germany
| | - Sat Bir S Khalsa
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Robert B Saper
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
15
|
Sorensen G, Nagler EM, Pawar P, Gupta PC, Pednekar MS, Wagner GR. Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries. PLoS One 2017; 12:e0182607. [PMID: 28837688 PMCID: PMC5570315 DOI: 10.1371/journal.pone.0182607] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/22/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs). METHODS This study-conducted in 22 manufacturing worksites in Mumbai, India-adapted and implemented an evidence-based intervention tested in the U.S. that integrated OSH and tobacco control. The systematic adaptation process included formative research and pilot testing, to ensure that the tested intervention was tailored to the local setting. We used qualitative methods and process evaluation to assess the extent to which this intervention was implemented, and to explore barriers to implementation. RESULTS While participating worksites agreed to implement this intervention, not all components of the adapted intervention were implemented fully in the 10 worksites assigned to the intervention condition. We found that the OSH infrastructure in India focused predominantly on regulatory compliance, medical screening (secondary prevention) and the treatment of injuries. We observed generally low levels of leadership support and commitment to OSH, evidenced by minimal management participation in the intervention, reluctance to discuss OSH issues with the study team or workers, and little receptivity to recommendations resulting from the industrial hygienist's reports. CONCLUSION India presents one example of a LMIC with a rising burden of non-communicable diseases and intensified exposures to both physical and organizational hazards on the job. Our experiences highlight the importance of national and global trends that shape workers' experiences on the job and their related health outcomes. Beyond a singular focus on prevention of non-communicable diseases, coordinated national and international efforts are needed to address worker health outcomes in the context of the conditions of work that clearly shape them.
Collapse
Affiliation(s)
- Glorian Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Eve M. Nagler
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Pratibha Pawar
- Healis, Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Prakash C. Gupta
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Healis, Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Mangesh S. Pednekar
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Healis, Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Gregory R. Wagner
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
16
|
LaMancuso K, Goldman RE, Nothnagle M. "Can I Ask That?": Perspectives on Perinatal Care After Resettlement Among Karen Refugee Women, Medical Providers, and Community-Based Doulas. J Immigr Minor Health 2017; 18:428-35. [PMID: 25724151 DOI: 10.1007/s10903-015-0172-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social contextual model and focused on women's questions about and opinions of perinatal care in Buffalo and on providers' experiences caring for Karen patients. Karen women expressed gratitude for and understanding of perinatal care in Buffalo, and providers described Karen patients as agreeable but shy. Karen doulas offered an alternative view that exposed women's many questions and concerns, and described how doula training empowered them as patients' advocates. Low self-efficacy, trauma histories, and cultural expectations may contribute to Karen women's seeming agreeability. Doulas/interpreters possess insider knowledge of women's concerns and facilitate communication between patients and the care team.
Collapse
Affiliation(s)
- Kate LaMancuso
- Department of Family Medicine, The Warren Alpert Medical School of Brown University/Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, 02860, RI, USA.
| | - Roberta E Goldman
- Department of Family Medicine, The Warren Alpert Medical School of Brown University/Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, 02860, RI, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Melissa Nothnagle
- Department of Family Medicine, The Warren Alpert Medical School of Brown University/Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, 02860, RI, USA
| |
Collapse
|
17
|
Aghi M, Nagler E, Lando H, Pednekar M, Gupta P, Sorensen G. Training Lay Interventionists to Support Tobacco Cessation among Teachers in India. INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 2016; 54:304-317. [PMID: 29151809 PMCID: PMC5687280 DOI: 10.1080/14635240.2016.1193761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite the rapidly increasing burden of tobacco-related morbidity and mortality in low- and middle-income countries, tobacco control initiatives - especially cessation - receive little emphasis. This is true despite low-cost methods that have potential for widespread dissemination. The purpose of this paper is to provide a case study example of how lay interventionists may be trained and supported to facilitate tobacco use cessation, based on the successful Tobacco Free Teachers-Tobacco Free Society program (TFT-TFS) implemented in Bihar, India. This school-based program included multiple components, with lay interventionists having a crucial role. The lay interventionists included health educators and lead teachers, both of whom were selected based on formative research, underwent extensive training and received continuing support. We emphasized encouraging and supporting teachers to quit tobacco use and engaging both tobacco users and nonusers to create a supportive environment for cessation. We also stressed that neither the health educators nor lead teachers were being trained as counselors or as cessation experts. We focused on the importance of respecting teachers as individuals and identifying locally relevant methods of cessation. Although we cannot isolate the precise contribution of the lay interventionists to the successful TFT-TFS intervention, the abstinence findings in favor of the intervention at follow up are highly encouraging. Teachers have been neglected as lay interventionists for tobacco cessation despite the fact that they tend to be highly respected and credible. The approach used for TFT-TFS could be disseminable in multiple low- and middle-income country contexts through train-the-trainer programs targeted to teachers.
Collapse
Affiliation(s)
- Mira Aghi
- Healis, Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, Navi Mumbai - 400 614 India Tel. 91 22 2757 5487
| | - Eve Nagler
- Dana-Farber Cancer Institute/Harvard School of Public Health, 450 Brookline Avenue Boston, MA 02215 USA, Tel. 617 582 8156
| | - Harry Lando
- University of Minnesota, 1300 S. 2 Street, Minneapolis, MN 55454 USA, tel. 612 624 1877
| | - Mangesh Pednekar
- Healis, Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, Navi Mumbai - 400 614 India, Tel. 91 22 2757 5487
| | - Prakash Gupta
- Healis, Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, Navi Mumbai - 400 614 India., Tel. 91 22 2757 5487
| | - Glorian Sorensen
- Dana-Farber Cancer Institute/Harvard School of Public Health, 450 Brookline Avenue, Boston, MA 02215 USA, Tel. 617 632 2183
| |
Collapse
|
18
|
Pawar PS, Nagler EM, Gupta PC, Stoddard AM, Lando HA, Shulman L, Pednekar MS, Kasisomayajula V, Aghi MB, Sinha DN, Sorensen GS. Tracking intervention delivery in the ‘Tobacco-Free Teachers/Tobacco-Free Society’ program, Bihar, India. HEALTH EDUCATION RESEARCH 2015; 30:731-41. [PMID: 26342136 PMCID: PMC4626741 DOI: 10.1093/her/cyv039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/06/2015] [Indexed: 05/09/2023]
Abstract
In health education and behavior change interventions, process tracking monitors the delivery of an intervention and its receipt to the intended audience. A randomized controlled trial in the state of Bihar, India was conducted to help school teachers become tobacco free through appropriately designed intervention program and delivery system. We describe the results from process tracking of this intervention delivery. The intervention program was centred on six topics delivered in each school through 12 sessions over 6 successive months. The program deliverers recorded the process measures as total number of sessions and program-components implemented (fidelity); time spent conducting sessions (dose) and proportion of teachers attending at least one session (reach). The outcome measures (teachers’ exposure to intervention messages and tobacco policy adoption) were assessed post-intervention. All 12 sessions were delivered in 33 out of 36 schools. Thirty-one schools implemented all six program components. In 18 schools, ≥95% of the teachers participated in one or more sessions. Thirty-three schools received 12 or more hours of dose. In 29 schools, 100% teachers reported exposure to all program messages. Tobacco policy was adopted by all schools. Thus, the intervention was generally delivered as planned and it had a positive impact on teachers and schools.
Collapse
Affiliation(s)
- P. S. Pawar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
- *Correspondence to: P. S. Pawar. E-mail: or
| | - E. M. Nagler
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - P. C. Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
| | - A. M. Stoddard
- Biostatistical Consultant, Pelham, Massachusetts 01002, USA
| | - H. A. Lando
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis 55455, USA and
| | - L. Shulman
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - M. S. Pednekar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
| | - V. Kasisomayajula
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - M. B. Aghi
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
| | - D. N. Sinha
- School of Preventive Oncology, Patna 800001, India
| | - G. S. Sorensen
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| |
Collapse
|
19
|
Nagler EM, Sinha DN, Pednekar MS, Stoddard AM, Gupta PC, Mathur N, Lando H, Aghi M, Cordeira LS, Viswanath K, Sorensen G. Social contextual factors and tobacco use among Indian teachers: insights from the Bihar School Teachers' Study. Prev Med 2015; 74:24-30. [PMID: 25657167 PMCID: PMC4617324 DOI: 10.1016/j.ypmed.2015.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tobacco use within India has significant effects on the global burden of tobacco-related disease. As role models and opinion leaders, teachers are at the forefront of tobacco control efforts, yet little is known about their own tobacco use. This study examines the association between factors in the social environment and tobacco use among teachers in Bihar, India. METHODS The study was based on the Bihar School Teachers' Study baseline survey. Seventy-two Bihar government schools (grades 8-10) were randomly selected for the study and all school personnel were invited to complete the survey in June/July in 2009 and 2010. We assessed the relation between social contextual factors and current smoking/smokeless tobacco use by fitting a series of logistic regression models. RESULTS After controlling for clustering of teachers in schools and other covariates, our results showed teachers with one or more coworkers who used tobacco were twice as likely to be smokeless tobacco users as teachers with no co-workers who used tobacco. Teachers who reported rules prohibiting smoking at home were significantly less likely to smoke than teachers without such rules. Older male teachers also had significantly greater odds of smoking/using smokeless tobacco. CONCLUSION These findings provide direction for future interventions targeting the social context.
Collapse
Affiliation(s)
- Eve M Nagler
- Dana-Farber Cancer Institute, Center for Community Based Research, 450 Brookline Ave, Boston, MA 02215, USA; Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue-7th Floor, Boston, MA 02115, USA.
| | - Dhirendra N Sinha
- WHO Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110002, India
| | - Mangesh S Pednekar
- Healis Sekhsaria Institute For Public Health, 501, Technocity, Plot-X-4/5, TTC Industrial Area, Mahape, Navi Mumbai, Pin code-400701, Maharashtra, India
| | - Anne M Stoddard
- New England Research Institutes, 480 Pleasant Street, Watertown, MA 02472, USA
| | - Prakash C Gupta
- Healis Sekhsaria Institute For Public Health, 501, Technocity, Plot-X-4/5, TTC Industrial Area, Mahape, Navi Mumbai, Pin code-400701, Maharashtra, India
| | - Neha Mathur
- Healis Sekhsaria Institute For Public Health, 501, Technocity, Plot-X-4/5, TTC Industrial Area, Mahape, Navi Mumbai, Pin code-400701, Maharashtra, India
| | - Harry Lando
- University of Minnesota School of Public Health, Division of Epidemiology & Community Health, 1300S. 2nd Street, Suite 300, Minneapolis, MN 55454, USA
| | - Mira Aghi
- Freelance Behavioral Scientist, New Delhi 110016, India
| | - Laura Shulman Cordeira
- Dana-Farber Cancer Institute, Center for Community Based Research, 450 Brookline Ave, Boston, MA 02215, USA
| | - K Viswanath
- Dana-Farber Cancer Institute, Center for Community Based Research, 450 Brookline Ave, Boston, MA 02215, USA; Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue-7th Floor, Boston, MA 02115, USA
| | - Glorian Sorensen
- Dana-Farber Cancer Institute, Center for Community Based Research, 450 Brookline Ave, Boston, MA 02215, USA; Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue-7th Floor, Boston, MA 02115, USA
| |
Collapse
|
20
|
Sorensen G, Pednekar MS, Sinha DN, Stoddard AM, Nagler E, Aghi MB, Lando HA, Viswanath K, Pawar P, Gupta PC. Effects of a tobacco control intervention for teachers in India: results of the Bihar school teachers study. Am J Public Health 2013; 103:2035-40. [PMID: 24028234 PMCID: PMC3828698 DOI: 10.2105/ajph.2013.301303] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed a school-based intervention designed to promote tobacco control among teachers in the Indian state of Bihar. METHODS We used a cluster-randomized design to test the intervention, which comprised educational efforts, tobacco control policies, and cessation support and was tailored to the local social context. In 2009 to 2011, we randomly selected 72 schools from participating school districts and randomly assigned them in blocks (rural or urban) to intervention or delayed-intervention control conditions. RESULTS Immediately after the intervention, the 30-day quit rate was 50% in the intervention and 15% in the control group (P = .001). At the 9-month postintervention survey, the adjusted 6-month quit rate was 19% in the intervention and 7% in the control group (P = .06). Among teachers employed for the entire academic year of the intervention, the adjusted 6-month abstinence rates were 20% and 5%, respectively, for the intervention and control groups (P = .04). CONCLUSIONS These findings demonstrate the potent impact of an intervention that took advantage of social resources among teachers, who can serve as role models for tobacco control in their communities.
Collapse
Affiliation(s)
- Glorian Sorensen
- Glorian Sorensen, Eve Nagler, and Kasisomayajula Viswanath are with the Dana-Farber Cancer Institute, and the Harvard School of Public Health, Boston, MA. Mangesh S. Pednekar and Prakash C. Gupta are with the Healis-Sekhsaria Institute of Public Health, Navi-Mumbai, India. Dhirendra N. Sinha is with the School of Preventive Oncology, Patna, Bihar, India. Anne M. Stoddard is with New England Research Institutes, Watertown, MA. Mira B. Aghi is a consulting behavioral scientist, New Delhi, India. Harry A. Lando is with the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis. Pratibha Pawar is with Healis-Sekhsaria Institute for Public Health, Navi-Mumbai, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Pischke CR, Galarce EM, Nagler E, Aghi M, Sorensen G, Gupta PC, Pednekar MS, Sinha DN, Viswanath K. Message formats and their influence on perceived risks of tobacco use: a pilot formative research project in India. HEALTH EDUCATION RESEARCH 2013; 28:326-38. [PMID: 23221589 PMCID: PMC3594928 DOI: 10.1093/her/cys112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 10/25/2012] [Indexed: 05/24/2023]
Abstract
In India, tobacco kills 900,000 people every year though the burden of tobacco is faced disproportionately in poorer states such as Bihar. Teachers may be a particularly influential group in setting norms around tobacco use in the Indian context. However, tobacco use among teachers remains high and perceptions of tobacco-related health risks are unexplored. To qualitatively explore perceptions about tobacco use among teachers in Bihar and to examine how risk information may be communicated through a variety of message formats, 12 messages on tobacco health risks varying in formats were tested in focus groups with teachers from Bihar. Participants stated that teachers were already aware of tobacco-related health risks. To further increase awareness of these risks, the inclusion of evidence-based facts in messages was recommended. Communicating risk information using negative emotions had a great appeal to teachers and was deemed most effective for increasing risk perception. Messages using narratives of teachers' personal accounts of quitting tobacco were deemed effective for increasing knowledge about the benefits of quitting. To conclude, messages using evidence-based information, possibly with negative emotions, testimonials with role models and those messages emphasizing self-efficacy in the format of narratives appear to appeal to teachers in Bihar.
Collapse
Affiliation(s)
- Claudia R Pischke
- BIPS - Institute for Epidemiology and Prevention Research, Bremen 28359, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|