Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK.
Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK.
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DOI：
10.1186/s12889-016-3177-8
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发表时间：
2016-06-10
影响因子：
4.5
通讯作者：
Khan J
中科院分区：
文献类型：
--
作者：
Siddiqi K;Dogar O;Rashid R;Jackson C;Kellar I;O'Neill N;Hassan M;Ahmed F;Irfan M;Thomson H;Khan J
南亚裔人占全世界无烟烟草消费量的四分之三以上;然而，几乎没有证据表明这一人群中戒烟干预措施的效果。南亚人使用具有强烈社会文化层面的高成瘾性和危险的毒品产品。我们设计了一个定制的行为改变干预（BCI），以支持南亚人戒烟，然后评估其在巴基斯坦和英国的可行性。我们进行了两个文献综述，以确定南亚人和行为改变技术（BCT）可能修改这些，分别使用的决定因素。迭代共识发展研讨会有助于为BCI选择有效的BCT，并设计活动和材料来实现这些目标。我们在32名使用者中试用了BCI。所有的BCI会话都进行了录音和分析，以遵守干预内容和互动质量（保真度指数）。16名参与者和5名顾问进行了深入访谈，分别评估了BCI的可接受性和可行性。在6个月时通过唾液/尿可替宁评估戒烟成功率。BCI包括23项活动和支持这些活动的互动图片资源。活动包括提高对滥用的危害和戒烟的好处的认识，提高客户的动机和自我效能，并制定策略来管理他们的触发因素，戒断症状和复发。槟榔和古斯卡是常见的槟榔。巴基斯坦的客户比英国的客户更依赖网络。在32名参与者中，有4名参与者在6个月时检测不到可替宁。每个网站的忠实度得分在11.2和42.6之间变化，以遵守内容-最高得分可达到44;和1.4和14之间的互动质量-最高得分可达到14。与顾问的访谈强调了对BCT进行额外培训的必要性，包括尼古丁替代和减少戒烟前会议的持续时间。客户接受健康信息，但大多数报告减少，而不是完全停止。我们开发了一种基于理论的BCI，也是可以接受的，并具有中等保真度分数的可行性。现在需要在有效性试验中对其进行评估。本文的在线版本（doi：10.1186/s12889-016-3177-8）包含补充材料，可供授权用户使用。
People 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. We 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. The 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. We 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. The online version of this article (doi:10.1186/s12889-016-3177-8) contains supplementary material, which is available to authorized users.