"Everything the hujur tells is very educative but if I cannot apply those in my own life then there is no meaning": a mixed-methods process evaluation of a smoke-free homes intervention in Bangladesh.
"Everything the hujur tells is very educative but if I cannot apply those in my own life then there is no meaning": a mixed-methods process evaluation of a smoke-free homes intervention in Bangladesh.
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DOI：
10.1186/s12889-022-14283-6
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发表时间：
2022-10-11
影响因子：
4.5
通讯作者：
中科院分区：
文献类型：
--
作者：
接触烟草产生的二手烟是全球发病率和死亡率的重要原因。孟加拉国的一项集群随机对照试验比较了在清真寺提供的基于社区的无烟家庭（SFH）干预措施，无论是否向家庭提供室内空气质量（IAQ）反馈。与没有使用二手烟客观衡量标准进行干预相比，这两种方法都没有效果，也没有成本效益。本文介绍了嵌入在审判过程中的评估，并试图了解这一点。 一个混合方法的过程评估，包括与30个家庭的领导和六个伊玛目（清真寺的祈祷领袖），900个家庭的领导（75%的答复）完成的简短问卷，在六个（20%）清真寺和研究小组的记录干预交付的忠诚度评估访谈。利用三个过程评价功能提供信息的元主题对数据进行了三角测量：执行、影响机制和背景。 实施：SFH干预措施交付的频率被判定为中等至良好。然而，干预措施的忠诚度和覆盖面差的程度参差不齐。将Ayahs（《古兰经》经文）与针对社会科学及人文科学态度的健康信息联系起来，往往得到充分实施，影响最大（沿着那些针对社会规范的信息）。IAQ反馈的频率和范围都很好。影响机制：两种干预措施都具有良好的可接受性。然而，对于干预措施在创建家庭健康系统方面的效用，人们的看法不一。行为改变的个人驱动因素是新的SFH知识，相应的积极态度，社会规范和意图。个人障碍是缺乏自我效能感和计划。背景：在清真寺实施SFH干预措施的社会背景驱动因素已经到位，而且很重要。没有报告执行方面的背景障碍。社会背景驱动SHS行为改变的是儿童的要求。障碍是妇女不愿意要求男子在外面吸烟，以及一般不愿意要求来访者吸烟。(Not)在室外有地方吸烟是一个物理环境（障碍）和驱动因素。尽管与相关利益相关者进行了详细的开发和适应工作，SFH干预和IAQ反馈成为教育干预措施，具有激励作用，但不足以克服重大的背景障碍，以减少客观测量的家庭SHS暴露。未来的干预措施可以有效地纳入对SFH行为改变的实际支持。此外，需要将这些纳入社区范围的战略，包括实际的戒烟支持和执行SFH立法。当前对照试验ISRCTN 49975452在线版本包含补充材料，可通过10.1186/s12889-022-14283-6获得。
Second-hand smoke exposure from tobacco significantly contributes to morbidity and mortality worldwide. A cluster RCT in Bangladesh compared a community-based smoke-free home (SFH) intervention delivered in mosques, with or without indoor air quality (IAQ) feedback to households to no intervention. Neither was effective nor cost-effective compared to no intervention using an objective measure of second-hand smoke. This paper presents the process evaluation embedded within the trial and seeks to understand this. A mixed method process evaluation comprising interviews with 30 household leads and six imams (prayer leader in mosque), brief questionnaire completed by 900 household leads (75% response), fidelity assessment of intervention delivery in six (20%) mosques and research team records. Data were triangulated using meta-themes informed by three process evaluation functions: implementation, mechanisms of impact and context. IMPLEMENTATION: Frequency of SFH intervention delivery was judged moderate to good. However there were mixed levels of intervention fidelity and poor reach. Linked Ayahs (verses of the Qur’an) with health messages targeting SHS attitudes were most often fully implemented and had greatest reach (along with those targeting social norms). Frequency and reach of the IAQ feedback were good. MECHANISMS OF IMPACT: Both interventions had good acceptability. However, views on usefulness of the interventions in creating a SFH were mixed. Individual drivers to behaviour change were new SFH knowledge with corresponding positive attitudes, social norms and intentions. Individual barriers were a lack of self-efficacy and plans. CONTEXT: Social context drivers to SFH intervention implementation in mosques were in place and important. No context barriers to implementation were reported. Social context drivers to SHS behaviour change were children’s requests. Barriers were women’s reluctance to ask men to smoke outside alongside general reluctance to request this of visitors. (Not) having somewhere to smoke outside was a physical context (barrier) and driver. Despite detailed development and adaption work with relevant stakeholders, the SFH intervention and IAQ feedback became educational interventions that were motivational but insufficient to overcome significant context barriers to reduce objectively measured SHS exposure in the home. Future interventions could usefully incorporate practical support for SFH behaviour change. Moreover, embedding these into community wide strategies that include practical cessation support and enforcement of SFH legislation is needed. Current Controlled Trials ISRCTN49975452 The online version contains supplementary material available at 10.1186/s12889-022-14283-6.
影响因子：
1.7
作者：
Kellar, Ian;Al Azdi, Zunayed;Jackson, Cath;Huque, Rumana;Mdege, Noreen Dadirai;Siddiqi, Kamran
通讯作者：
Siddiqi, Kamran