Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK

BMC Public Health

Research Article

Rukhsana Rashid¹  Furqan Ahmed²  Kamran Siddiqi³  Nancy O’Neill³  Omara Dogar³  Cath Jackson³  Maryam Hassan⁴  Muhammad Irfan⁴  Javaid Khan⁴  Heather Thomson⁵  Ian Kellar⁶ 

[1] Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK;Cameos Consultants, Islamabad, Pakistan;Department of Health Sciences, University of York, YO10 5DD, York, UK;Department of Medicine, The Aga Khan University, Karachi, Pakistan;Department of Public Health, Leeds City Council, LS7 3NB, Leeds, UK;School of Psychology, University of Leeds, LS2 9JT, Leeds, UK;

关键词: Tobacco;    Smokeless;    Chewing;    South Asian;    Behavioural support;    Behaviour change;    Fidelity;    Adaptation;    Cessation;    Feasibility;   

DOI  :  10.1186/s12889-016-3177-8

 received in 2015-12-29, accepted in 2016-06-02,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundPeople of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK.MethodsWe conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine.ResultsThe BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation.ConclusionWe developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.

【 授权许可】

CC BY   
© The Author(s). 2016