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Pahwa V, Pimple SA, Bhattacharjee A, Kuberkar D, Mishra GA, Chaturvedi P. Behavioural interventions for tobacco cessation in India: A systematic review and meta-analysis. J Family Med Prim Care 2023; 12:2542-2551. [PMID: 38186806 PMCID: PMC10771179 DOI: 10.4103/jfmpc.jfmpc_1017_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 01/09/2024] Open
Abstract
Tobacco consumption is an area of public health concern in India. One of the unmet needs of many low-resource countries is to provide cost-effective tobacco cessation interventions for reducing tobacco-related mortality. This article reviews studies on non-pharmacological interventions for tobacco cessation in India. A systematic review by PICO (population, intervention, comparison, outcome) of behavioural intervention-based tobacco cessation studies that met the inclusion criteria, with a minimum 1-month follow-up, reporting outcomes in terms of frequencies or percentages published between 2010 and 2020 was performed. Following the review stages, 16 studies comprising 9,613 participants were included in the review. A pooled estimate was derived using both fixed-effects and random-effects models. The intervention showed good overall efficacy for any tobacco user (relative risk [RR] = 1.73 [95% confidence interval [CI]: 1.58-1.90) (fixed-effect model)] and (RR = 2.02 [95% CI: 1.64-2.48] [random-effects model]). Behavioural intervention studies targeted towards only smokers (RR of 1.81 [95% CI: 1.55-2.11] and 1.96 [95% CI: 1.52-2.53]) and combined smoking and smokeless tobacco users (RR of 1.69 [95% CI: 1.50-1.90] and 2.12 [95% CI: 1.49-3.01]) were equally efficacious. The review provides the effectiveness of behavioural interventions in quitting tobacco among users of both smoking and smokeless forms of tobacco. The review findings are of particular significance to inform health policy decisions on the integration of cost-effective brief behavioural intervention into existing health care services in resource-constrained countries.
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Affiliation(s)
- Vandita Pahwa
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital and Research Center, New Chandigarh, Punjab, India
| | - Sharmila A. Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepali Kuberkar
- Department of Library Science, Digital Library, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gauravi A. Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head Neck Surgery, Deputy Director, Centre for Cancer Epidemiology (CCE), Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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Ngo QC, Doan LPT, Vu GV, Phan TP, Chu HT, Duong AT, Vuong QH, Ho MT, Nguyen MH, Vuong TT, Nguyen TT, Nguyen HT, Nguyen AHT, Ho CSH, Ho RCM. Telephone-Based Smoking Cessation Counseling Service: Satisfaction and Outcomes in Vietnamese Smokers. Healthcare (Basel) 2022; 11:healthcare11010135. [PMID: 36611595 PMCID: PMC9819398 DOI: 10.3390/healthcare11010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND As a method to acknowledge the devastating health and economic impacts of tobacco usage worldwide, telephone-based tobacco cessation counseling services have emerged as a potential tool to aid people in their quitting process. This study explores the satisfaction of smokers who use the QUITLINE service and factors associated with their quit attempts and cessation. METHODS A cross-sectional survey of 110 participants was conducted from June to July 2016 at the Respiratory Center at Bach Mai Hospital, Hanoi, Vietnam. Multivariate logistic regression was used, and it was found that the percentage of people quitting smoking increased after using the service. RESULTS In total, 65.5% of participants were completely satisfied with the counseling service. The mean score of staff/s capacity/responsiveness, motivation, and service convenience were 4.37 ± 0.78, 4.30 ± 0.81, and 4.27 ± 0.66, respectively. The smoking relapse rate was relatively high at 58.3%, which mainly resulted from cravings and busy work (26.2% and 14.3%, respectively). A higher satisfaction score in "Staffs' capacity and responsiveness" was negatively associated with "ever tried to quit smoking in consecutive 24 h" and actually quit smoking after receiving counseling. Meanwhile, a higher score in the "Motivation" domain was positively associated with both quit attempt indicators as well as actually quitting smoking after receiving counseling (OR = 9.48; 95%CI = 2.27; 39.57). CONCLUSIONS These results suggest that it is crucial for decision makers to place more focus on countermeasures for smoking relapse and to strengthen the capacity of staff, especially in motivating clients. Interventions should also be maintained throughout a long period of time to prevent relapse.
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Affiliation(s)
- Quy-Chau Ngo
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | | | - Giap Van Vu
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Thu-Phuong Phan
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Hanh Thi Chu
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Anh Tu Duong
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Quan-Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi 100803, Vietnam
| | - Manh-Tung Ho
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi 100803, Vietnam
| | - Minh-Hoang Nguyen
- Ritsumeikan Asia Pacific University, Beppu City 874-8577, Oita Prefecture, Japan
| | | | - Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Nursing, Duy Tan University, Da Nang 550000, Vietnam
- Correspondence:
| | - Hien Thu Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Nursing, Duy Tan University, Da Nang 550000, Vietnam
| | | | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
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Shelley D, Cleland CM, Nguyen T, Van Devanter N, Siman N, Van M H, Nguyen NT. Effectiveness of a multicomponent strategy for implementing guidelines for treating tobacco use in Vietnam Commune Health Centers. Nicotine Tob Res 2021; 24:196-203. [PMID: 34543422 DOI: 10.1093/ntr/ntab189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). METHODS We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n=26) in Vietnam. Arm 1 included training and a tool kit (e.g., reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As+R). Provider surveys were conducted at baseline, six- and 12-months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. RESULTS Adoption of the 4As increased significantly across both study arms (all p<.001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. CONCLUSION The study demonstrated the effectiveness of a multicomponent and multilevel strategy (i.e., provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. IMPLICATIONS Improving implementation of evidence-based tobacco dependence treatment (TDT) guidelines is a necessary step towards reducing the growing burden of non-communicable disease (NCDs) and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam, and offers a potentially scalable model for meeting FCTC Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a community health worker for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use.
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Affiliation(s)
- D Shelley
- New York University School of Global Public Health, New York, NY
| | - C M Cleland
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
| | - N Van Devanter
- Rory Myers College of Nursing, New York University, New York, NY
| | - N Siman
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - Hoang Van M
- Minh Hoang Van, MD, Hanoi University of Public Health, Duc Thang Ward, North Tu Liem district, Hanoi, Vietnam
| | - N T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
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VanDevanter N, Vu M, Nguyen A, Nguyen T, Van Minh H, Nguyen NT, Shelley DR. A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers. Implement Sci 2020; 15:73. [PMID: 32907603 PMCID: PMC7488010 DOI: 10.1186/s13012-020-01035-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability. Methods We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis. Results Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains. Conclusion Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users. Trial registration NCT02564653, registered September 2015
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Affiliation(s)
- Nancy VanDevanter
- Rory Myers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Ann Nguyen
- Department of Population Health, NYU Langone Health, 180 Madison Ave., 17th floor, New York, NY, 10016, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Hoang Van Minh
- Hanoi University of Public Health, No 1A Duc Thang Street, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Nam Truong Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Donna R Shelley
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10012, USA.
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Jiang N, Siman N, Cleland CM, Van Devanter N, Nguyen T, Nguyen N, Shelley D. Effectiveness of Village Health Worker-Delivered Smoking Cessation Counseling in Vietnam. Nicotine Tob Res 2019; 21:1524-1530. [PMID: 30335180 PMCID: PMC6941703 DOI: 10.1093/ntr/nty216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking prevalence is high in Vietnam, yet tobacco dependence treatment (TDT) is not widely available. METHODS We conducted a quasiexperimental study that compared the effectiveness of health care provider advice and assistance (ARM 1) versus ARM 1 plus village health worker (VHW) counseling (ARM 2) on abstinence at 6-month follow-up. This study was embedded in a larger two-arm cluster randomized controlled trial conducted in 26 community health centers (CHCs) in Vietnam. Subjects (N = 1318) were adult patients who visited any participating CHC during the parent randomized controlled trial intervention period and were self-identified as current tobacco users (cigarettes and/or water pipe). RESULTS At 6-month follow-up, abstinences rates in ARM 2 were significantly higher than those in ARM 1 (25.7% vs. 10.5%; p < .001). In multivariate analyses, smokers in ARM 2 were almost three times more likely to quit compared with those in ARM 1 (adjusted odds ratio [AOR] = 2.96, 95% confidence interval [CI] = 1.78% to 4.92%). Compared to cigarette-only smokers, water pipe-only smokers (AOR = 0.4, 95% CI = 0.26% to 0.62%) and dual users (AOR = 0.62, 95% CI = 0.45% to 0.86%) were less likely to achieve abstinence; however, the addition of VHW counseling (ARM 2) was associated with higher quit rates compared with ARM 1 alone for all smoker types. CONCLUSION A team approach in TDT programs that offer a referral system for health care providers to refer smokers to VHW-led cessation counseling is a promising and potentially scalable model for increasing access to evidence-based TDT and increasing quit rates in low middle-income countries (LMICs). TDT programs may need to adapt interventions to improve outcomes for water pipe users. IMPLICATIONS The study fills literature gaps on effective models for TDT in LMICs. The addition of VHW-led cessation counseling, available through a referral from primary care providers in CHCs in Vietnam, to health care provider's brief cessation advice, increased 6-month biochemically validated abstinence rates compared to provider advice alone. The study also demonstrated the potential effectiveness of VHW counseling on reducing water pipe use. For LMICs, TDT programs in primary care settings with a referral system to VHW-led cessation counseling might be a promising and potentially scalable model for increasing access to evidence-based treatment.
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Affiliation(s)
- Nan Jiang
- Department of Population Health, New York University, New York, NY
| | - Nina Siman
- Department of Population Health, New York University, New York, NY
| | | | | | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Donna Shelley
- Department of Population Health, New York University, New York, NY
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Long H, Ma Z, Hanh TTD, Minh HV, Rawal LB, Urmi DS, Jafar TH, Tang S, Abdullah AS. Engaging village health workers in non-communicable disease (NCD) prevention and control in Vietnam: A qualitative study. Glob Public Health 2019; 15:611-625. [PMID: 31630629 DOI: 10.1080/17441692.2019.1678660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The burden of non-communicable diseases (NCDs) continues to grow in Vietnam, and reducing the burden of NCDs is a national priority. This study explored perspective of community health workers (CHWs), known as Village Health Workers (VHWs) in Vietnam, and public health leaders towards potential of expanding VHWs' role to deliver NCDs prevention and control services, and determined barriers and facilitators. We conducted focus group discussions (FGDs) with VHWs (n = 24) and in-depth interviews (IDIs) with public health administrators (n = 13). The findings show that VHWs in Vietnam deliver multiple public health services, including several NCDs related services. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Facilitators include government commitment to NCDs prevention and control, priority on capacity building, professional recognition and provision of incentives with availability of appropriate resources. While additional quantitative studies are needed to supplement the current qualitative findings, the current results inform the policy and intervention development in engaging VHWs in the delivery of community-based NCDs prevention and control initiatives in Vietnam.
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Affiliation(s)
- Hongfei Long
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China
| | - Zhenyu Ma
- School of Public Health, Guangxi Medical University, Guangxi, People's Republic of China
| | | | | | - Lal B Rawal
- School of Health, Medical and Applied Sciences, CQ University, Sydney Campus, Australia
| | - Dilshat S Urmi
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China
| | - Tazeen H Jafar
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China.,Duke Global Health Institute, Duke University, Durham, NC, USA.,Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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Nguyen N, Nguyen T, Truong V, Dang K, Siman N, Shelley D. Impact of a tobacco cessation intervention on adherence to tobacco use treatment guidelines among village health workers in Vietnam. Glob Health Promot 2019; 27:24-33. [PMID: 31319786 DOI: 10.1177/1757975919854032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community health workers (in Vietnam referred to as village health workers) have the potential to play a key role in expanding access to evidence-based tobacco use treatment. We conducted a cluster randomized controlled trial in community health centers in Vietnam that compared the effect of provider advice and cessation assistance (i.e. brief counseling and patient education materials) (BC) vs. BC + three sessions of in-person counseling delivered by a village health worker (BC+R) on providers' and village health workers' adherence to tobacco use treatment guidelines. All village health workers and health care providers received training. This paper presents data on the effect of the intervention on village health workers' adherence to tobacco use treatment guidelines, including asking about tobacco use, advising smokers to quit, offering assistance and their attitude, norms, and self-efficacy related to tobacco use treatment. We examined changes in adherence to tobacco use treatment guidelines before and 12 months after the intervention among 89 village health workers working in the 13 community health centers enrolled in the BC+R study condition. Village health workers' adherence to tobacco use treatment guidelines increased significantly. Village health workers were more likely to ask about tobacco use (3.4% at baseline, 32.6% at 12 months), offer advice to quit (4.5% to 48.3%) and offer assistance (1.1% to 38.2%). Perceived barriers to treating tobacco use decreased significantly. Self-efficacy and attitudes towards treating tobacco use improved significantly. Increased adherence to tobacco use treatment guidelines was associated with positive attitudes towards their role in delivering tobacco use treatment and increasing awareness of the community health center smoke-free policy. The findings suggest that, with training and support systems, village health workers can extend their role to include smoking cessation services. This workforce could represent a sustainable resource for supporting smokers who wish to quit.
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Affiliation(s)
- Nam Nguyen
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Trang Nguyen
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Van Truong
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Kim Dang
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Nina Siman
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Warsi S, Elsey H, Boeckmann M, Noor M, Khan A, Barua D, Nasreen S, Huque S, Huque R, Khanal S, Shrestha P, Newell J, Dogar O, Siddiqi K. Using behaviour change theory to train health workers on tobacco cessation support for tuberculosis patients: a mixed-methods study in Bangladesh, Nepal and Pakistan. BMC Health Serv Res 2019; 19:71. [PMID: 30683087 PMCID: PMC6347762 DOI: 10.1186/s12913-019-3909-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by health workers effectively promotes tobacco cessation. There is, however, a paucity of training to support LMIC health workers deliver effective tobacco cessation behavioural support. The TB and Tobacco Consortium undertook research in South Asia to understand factors affecting TB health workers’ delivery of tobacco cessation behavioural support, and subsequently developed a training package for LMICs. Methods Using the “capability, opportunity, and motivation as determinants of behaviour” (COM-B) framework to understand any issues facing health worker delivery of behaviour support, we analysed 25 semi-structured interviews and one focus group discussion with TB health workers, facility in-charges, and national tuberculosis control programme (NTP) staff members in each country. Results were integrated with findings of an adapted COM-B questionnaire on health worker confidence in tobacco cessation support delivery, administered to 36 TB health workers. Based on findings, we designed a guide and training programme on tobacco cessation support for health workers. Results Qualitative results highlighted gaps in the majority of health workers’ knowledge on tobacco cessation and TB and tobacco interaction, inadequate training on patient communication, insufficient resources and staff support, and NTPs’ non-prioritization of tobacco cessation in all three countries. Questionnaire results reiterated the knowledge deficits and low confidence in patient communication. Participants suggested strengthening knowledge, skills, and competence through training and professional incentives. Based on findings, we developed an interactive two-day training and TB health worker guide adaptable for LMICs, focusing on evidence of best practice on TB and tobacco cessation support, communication, and rapport building with patients. Conclusions TB health workers are essential in addressing the dual burden of TB and tobacco faced by many LMICs. Factors affecting their delivery of tobacco cessation support can be identified using the COM-B framework, and include issues such as individuals’ knowledge and skills, as well as structural barriers like professional support through monitoring and supervision. While structural changes are needed to tackle the latter, we have developed an adaptable and engaging health worker training package to address the former that can be delivered in routine TB care. Trial registration ISRCTN43811467. Electronic supplementary material The online version of this article (10.1186/s12913-019-3909-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahil Warsi
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Helen Elsey
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Maryam Noor
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Amina Khan
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Deepa Barua
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Shammi Nasreen
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Samina Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Rumana Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Sudeepa Khanal
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - Prabin Shrestha
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - James Newell
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Omara Dogar
- The Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Kamran Siddiqi
- The Hull York Medical School, University of York, York, YO10 5DD, UK
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Introducing post-discharge malaria chemoprevention (PMC) for management of severe anemia in Malawian children: a qualitative study of community health workers' perceptions and motivation. BMC Health Serv Res 2018; 18:984. [PMID: 30567567 PMCID: PMC6299958 DOI: 10.1186/s12913-018-3791-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Severe malarial anaemia is one of the leading causes of paediatric hospital admissions in Malawi. Post-discharge malaria chemoprevention (PMC) is the intermittent administration of full treatment courses of antimalarial to children recovering from severe anaemia and findings suggest that this intervention significantly reduces readmissions and deaths in these children. Community delivery of health interventions utilizing community health workers (CHWs) has been successful in some programmes and not very positive in others. In Malawi, there is an on-going cluster randomised trial that aims to find the optimum strategy for delivery of dihydroartemesinin-piperaquine (DHP) for PMC in children with severe anaemia. Our qualitative study aimed to explore the feasibility of utilizing CHWs also known as health surveillance assistants (HSAs) to remind caregivers to administer PMC medication in the existing Malawian health system. Methods Between December 2016 and March 2018, 20 individual in-depth-interviews (IDIs) and 2 focus group discussions (FGDs) were conducted with 39 HSAs who had the responsibility of conducting home visits to remind caregivers of children who were prescribed PMC medication in the trial. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were uploaded to NVIVO 11 and analysed using the thematic framework analysis method. Results Although intrinsic motivation was reportedly high, adherence to the required number of home visits was very poor with only 10 HSAs reporting full adherence. Positive factors for adherence were the knowledge and perception of the effectiveness of PMC and the recognition from the community as well as health system. Poor training, lack of supervision, high workload, as well as technical and structural difficulties; were reported barriers to adherence by the HSAs. Conclusions Post-discharge malaria chemoprevention with DHP is perceived as a positive approach to manage children recovering from severe anaemia by HSAs in Malawi. However, adherence to home visit reminders was very poor and the involvement of HSAs in a scale up of this intervention may pose a challenge in the existing Malawian health system. Trial registration ClinicalTrials.gov identifier NCT02721420. The trial was registered on 26 March 2016. Electronic supplementary material The online version of this article (10.1186/s12913-018-3791-5) contains supplementary material, which is available to authorized users.
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Topp SM, Abimbola S, Joshi R, Negin J. How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review. Health Policy Plan 2018; 33:298-312. [PMID: 29272396 PMCID: PMC5886169 DOI: 10.1093/heapol/czx169] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/26/2022] Open
Abstract
Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner’s systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five ‘context’ related categories and four health system ‘capability’ themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an ‘integration preparedness tool’.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4812, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Seye Abimbola
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Rohina Joshi
- The George Institute, University of New South Wales, NSW 2042, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
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Li L, Hien NT, Liang LJ, Lin C, Lan CW, Lee SJ, Tuan NA, Tuan LA, Thanh DC, Ha NTT. Efficacy of Communication Training of Community Health Workers on Service Delivery to People Who Inject Drugs in Vietnam: A Clustered Randomized Trial. Am J Public Health 2018; 108:791-798. [PMID: 29672144 DOI: 10.2105/ajph.2018.304350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the efficacy of an intervention targeted to commune health workers (CHWs) who deliver services to people who inject drugs (PWID) in Vietnam. METHODS From 2014 to 2016, we conducted a cluster randomized controlled trial of 300 CHWs and 900 PWID in 60 communes in 2 provinces of Vietnam. Intervention CHWs participated in training sessions to enhance their communication skills. Trained CHWs were asked to deliver individual sessions to PWID. We assessed the outcomes at baseline and at 3-, 6-, 9-, and 12-month follow-ups. RESULTS Intervention CHWs showed greater improvement in provider-client interactions than did control CHWs at all follow-ups (range of difference = 3.33-5.18; P < .001). Intervention CHWs showed greater reduction in negative attitudes toward PWID at the 12-month follow-up (mean ±SD = 1.75 ±0.50; P < .001). PWID in the intervention group exhibited greater improvement in drug avoidance than did those in the control group from the 6-month follow-up on (range of difference = 1.21-1.65; P < .001). We observed no intervention effect on heroin use as measured by urinalysis. CONCLUSIONS This intervention targeting CHWs could lead to desired outcomes for both CHWs and PWID. ClinicalTrials.gov: NCT0213092.1.
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Affiliation(s)
- Li Li
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nguyen Tran Hien
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Li-Jung Liang
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Chunqing Lin
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Chiao-Wen Lan
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Sung-Jae Lee
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nguyen Anh Tuan
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Le Anh Tuan
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Duong Cong Thanh
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nguyen Thi Thanh Ha
- Li Li, Li-Jung Liang, Chunqing Lin, Chiao-Wen Lan, and Sung-Jae Lee are with the Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles. Nguyen Tran Hien, Nguyen Anh Tuan, Le Anh Tuan, Duong Cong Thanh, and Nguyen Thi Thanh Ha are with the HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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Minh HV, Ngan TT, Mai VQ, My NTT, Chung LH, Kien VD, Anh TT, Ngoc NB, Giap VV, Cuong NM, Manh PD, Giang KB. Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges. Asian Pac J Cancer Prev 2017; 17:1-9. [PMID: 27087176 DOI: 10.7314/apjcp.2016.17.s1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In Vietnam, the WHO Framework Convention on Tobacco Control (WHO FCTC) took effect in March 2005 while MPOWER has been implemented since 2008. This paper describes the progress and challenges of implementation of the MPOWER package in Vietnam. We can report that, in term of monitoring, Vietnam is very active in the Global Tobacco Surveillance System, completing two rounds of the Global Adult Tobacco Survey (GATS) and three rounds of the Global Youth Tobacco Survey (GYTS). To protect people from tobacco smoke, Vietnam has issued and enforced a law requiring comprehensive smoking bans at workplaces and public places since 2013. Tobacco advertising and promotion are also prohibited with the exception of points of sale displays of tobacco products. Violations come in the form of promotion girls, corporate social responsibility activities from tobacco manufacturers and packages displayed by retail vendors. Vietnam is one of the 77 countries that require pictorial health warnings to be printed on cigarette packages to warn about the danger of tobacco and the warnings have been implemented effectively. Cigarette tax is 70% of factory price which is equal to less than 45% of retail price and much lower than the recommendation of WHO. However, Vietnam is one of the very few countries that require manufacturers and importers to make "compulsory contributions" at 1-2% of the factory price of cigarettes sold in Vietnam for the establishment of a Tobacco Control Fund (TCF). The TCF is being operated well. In 2015, 67 units of 63 provinces/cities, 22 ministries and political-social organizations and 6 hospitals received funding from TCF to implement a wide range of tobacco control activities. Cessation services have been starting with a a toll-free quit-line but need to be further strengthened. In conclusion, Vietnam has constantly put efforts into the tobacco control field with high commitment from the government, scientists and activists. Though several remarkable achievements have been gained, many challenges remain. To overcome those challenges, implementation strategies that take into account the contextual factors and social determinants of tobacco use in Vietnam are needed.
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Nguyen N, Nguyen T, Chapman J, Nguyen L, Kumar P, VanDevanter N, Shelley D. Tobacco cessation in Vietnam: Exploring the role of village health workers. Glob Public Health 2017; 13:1265-1275. [PMID: 28776481 DOI: 10.1080/17441692.2017.1360376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to explore current tobacco use treatment (TUT) practice patterns, and attitudes and beliefs among Village Health Workers (VHWs) about expanding their role to include delivering smoking cessation interventions and the perceived barriers. We conducted a survey of 449 VHWs from 26 communes in Thai Nguyen province, Vietnam. We assessed TUT practice patterns including asking about tobacco use, advising smokers to quit, offering assistance (3As) and attitudes, self-efficacy, and norms related to TUT. Seventy two per cent of VHWs reported asking patients if they use tobacco, 78.6% offered advice to quit, and 41.4% offered cessation assistance to few or more patients in the past month. Self-efficacy was low, with 53.2% agreeing that they did not have the skills to counsel patients about smoking cessation. The most commonly reported barriers to offering TUT were a lack of training and perceived lack of patient interest. Greater awareness of their commune health centre's smoke-free policy and higher levels of self-efficacy were associated with screening and offering cessation assistance. VHWs support an expanded role in tobacco cessation, but require additional resources and training to increase their self-efficacy and skills to provide effective treatment.
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Affiliation(s)
- Nam Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Trang Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Jessica Chapman
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Linh Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Pritika Kumar
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Nancy VanDevanter
- c New York University Rory Meyers College of Nursing , New York , NY , USA
| | - Donna Shelley
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
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Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments-2015. J Urban Health 2017; 94:525-533. [PMID: 28656541 PMCID: PMC5533671 DOI: 10.1007/s11524-017-0180-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.
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Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system. Implement Sci 2017; 12:27. [PMID: 28241770 PMCID: PMC5330005 DOI: 10.1186/s13012-017-0558-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC. Methods We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study. Results The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting). Conclusions In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC. Trial registration NCT02564653. Registered September 2015
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