Challenges of Integrating Tobacco Cessation Interventions in TB Programmes: Case Studies from Nepal and Pakistan
Challenges of Integrating Tobacco Cessation Interventions in TB Programmes: Case Studies from Nepal and Pakistan
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DOI：
10.1017/jsc.2015.20
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发表时间：
2016-06-01
影响因子：
0.9
通讯作者：
Siddiqi, Kamran
中科院分区：
文献类型：
--
作者：
Dogar, Omara;Elsey, Helen;Siddiqi, Kamran
引言：由于结核病与烟草使用之间的相互作用以及戒烟的潜在益处，向结核病患者提供戒烟干预措施是非常可取的。然而，在结核病规划中实施这类干预措施仍然是一个挑战，也是一个研究不足的领域。我们以尼泊尔和巴基斯坦在结核病规划中实施戒烟的两项举措作为案例研究，描述了这些挑战，并强调了在这一过程中吸取的经验教训。方法：我们首先对两项倡议的所有已发表和未发表的报告进行了文献回顾，包括相关的定性和定量数据及其分析。然后，我们使用实施研究综合框架（CFIR）在五个实施领域下分析了这些信息：干预特征、外部环境、内部环境、参与者特征和实施过程。研究结果：在尼泊尔和巴基斯坦的结核病规划中实施戒烟时，我们面临着许多挑战。这些问题包括：对干预措施的背景相关性的怀疑，有利于吸烟的环境和文化转变的政治惰性，服务提供者的工作量，优先事项及其提供戒烟的动机和能力，以及实施过程中的培训和支持不足。我们了解到，通过使干预措施适应当地情况，获得上级当局的授权，使任务与服务提供者的角色和接受程度相一致，通过适当的培训和在实施期间提供支持、监测和反馈来建设能力，可以帮助将戒烟纳入结核病规划。结论：现有研究的经验教训可以帮助结核病规划实施戒烟干预措施，并使戒烟服务在常规结核病治疗中得到更好的整合和可持续性。
Introduction: Offering tobacco cessation interventions to TB patients is highly desirable due to the interaction between TB and tobacco use and the potential benefits of quitting. However, implementing such interventions in TB programmes remains a challenge and an under-researched area. Using two initiatives to implement tobacco cessation within TB programmes in Nepal and Pakistan as case studies, we describe these challenges and highlight lessons learnt in the process.Methods: We first conducted a documentary review of all published and unpublished reports of the two initiatives including relevant qualitative and quantitative data and its' analyses. We then analysed this information using the Consolidated Framework for Implementation Research (CFIR) under the five domains of implementation: intervention characteristics, outer settings, inner settings, participant characteristics and the process of implementation.Findings: We faced a number of challenges in implementing tobacco cessation within TB programmes both in Nepal and in Pakistan. These included: doubts about the contextual relevance of the intervention, environments conducive to smoking and political inertia for a cultural shift, service providers' workload, priorities, and their motivation and capacity to deliver tobacco cessation, and inadequate training and support during implementation. We learned that by adapting intervention to the local context, securing mandate from higher authorities, aligning tasks to service providers' roles and receptivity, building capacity through adequate training and providing support, monitoring and feedback during implementation can help in integrating tobacco cessation within TB programmes.Conclusions: Lessons from existing studies can help TB programmes in implementing tobacco cessation interventions and enable greater integration and sustainability of cessation services within routine TB care.