Pragmatic pilot cluster randomised control trial of a school-based peer-led anti-smoking intervention for 13-14 year olds in Malaysia

School-based interventions targeting substance use among young people in low-and-middle-income countries: A scoping review

BACKGROUND AND AIM

Globally, harmful substance use is among the leading causes of premature deaths in the general population, and most of these behaviours are initiated during pre-adolescence to young adulthood. Preventing the onset or reducing the prevalence of substance use among young people is thus a global health priority. Diverse school-based interventions have been implemented in low-and-middle-income countries (LMICs); however, evidence regarding their theoretical underpinnings and core components is lacking. The aim of this scoping review was to identify the underlying (social/behavioural) theories, models or frameworks (TMF) and core (practical) components of school-based interventions in LMICs aimed at preventing the onset or reducing the prevalence of substance use among young people.

METHODS

Using the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched scientific literature databases for articles published from 1995 to 2022. A further search was conducted using the reference lists of included articles. We selected randomized and non-randomized trials of school-based interventions in LMICs that aimed at preventing the onset or reducing the prevalence of substance use among young people. We used Covidence software to screen titles and abstracts, as well as full texts. We then extracted the data and analysed it using a descriptive content analysis approach. Two reviewers conducted the screening, extraction and data analysis and discussed discrepancies, and clarified doubts and uncertainties through consultation with the other team members.

FINDINGS

A total of 58 articles were included in the review. Most articles (63.8%) used either a single or combination of two or more TMFs to inform their interventions. The most widely used TMF was social learning theory followed by theory of planned behaviour. We identified six core components of substance use prevention interventions: education, school environment, school policy, parental involvement, peer engagement and counselling.

CONCLUSION

This scoping review outlines the core components of school-based substance use prevention interventions used in low-and-middle-income countries and the common theories, models or frameworks that underpin the design of those interventions.

Implementing lung health interventions in low- and middle-income countries: a FRESH AIR systematic review and meta-synthesis

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