Scaling up tobacco control in India: Comparing smartphone to in-person training for implementing an evidence-based intervention to reduce tobacco use among schoolteachers

项目摘要：在低收入和中等收入国家，与烟草有关的死亡人数迅速上升。在……里面 仅印度一国，每年就有超过120万人死于烟草。减少这些死亡人数将需要 大规模实施促进戒烟的循证干预措施。 然而，鉴于开展面对面培训的覆盖范围有限和后勤挑战， 对于控制烟草的EBIs，需要能够更广泛、灵活和低成本地实施的新模式。 在实施和扩大这种强有力的烟草控制EBI之前，与烟草有关的死亡率将继续下降。 站起来。我们的长期目标是确定有效、低资源的战略，以促进广泛的实施 在LMICs中控制烟草的EBIs。这项研究建立在一项针对学校教师的干预措施之上，该干预措施被称为烟草 免费教师，无烟草社会(TFT-TFS)计划，被证明在增加烟草使用方面有效 在一项整群随机试验中停药。印度教师是推广烟草的重要渠道 控制，因为他们是社区领袖和榜样。这项研究的下一个关键步骤是我们的 这里的目标是比较TFT-TFS计划在交付时的实施情况和效果 通过面对面培训与基于智能手机的培训模式。智能手机在教育领域的应用 Setting在印度已经很普及，提供了一种现成的、低成本的战略，用于扩大关于 TFT-TFS程序。通过智能手机提供TFT-TFS培训，该计划的潜在覆盖范围 可以乘以面对面培训所能达到的效果。我们将进行一次比较 使用整群随机设计的有效性试验，在该试验中，印度 中央邦将被随机分配接受面对面培训或通过智能手机接受培训 TFT-TFS程序。一旦接受培训，两个小组的校长都将在他们的 学校。我们将从计划实施、效果、成本和覆盖范围等方面对培训部门进行比较。 这项混合三期研究将以实施研究综合框架和RE-AIM为指导 框架；我们将使用混合方法来分析影响结果的因素。因此，我们的具体情况 目标是：(1)开发基于系统评估的面对面和基于智能手机的培训模式 中央邦的背景因素；(2)比较计划实施的保真度、有效性和成本 两种培训模式；以及(3)确定面对面培训与 使用混合方法设计的基于智能手机的培训。这个项目是创新的，改变了现状 从昂贵、时间密集的面对面培训到基于智能手机的培训模式，以扩大烟草行业的规模 控制EBIS。这项拟议的研究具有重要意义，因为它引入了一种减少烟草的新方法 使用和相关死亡，并演示如何通过智能手机进行培训以推广其他公众 资源有限地区与健康相关的EBI。

Project Summary: Tobacco-related deaths are rising rapidly in low and middle-income countries (LMICs). In India alone, tobacco use accounts for over 1.2 million deaths each year. Reducing these deaths will require large-scale implementation of evidence-based interventions (EBIs) that promote tobacco use cessation. However, given the limited reach and logistical challenges of conducting in-person training to implement tobacco-control EBIs, new models are needed that can be implemented more broadly, flexibly and at low cost. Until such robust tobacco-control EBIs are implemented and scaled, tobacco-related mortality will continue to rise. Our long-term goal is to identify effective, low-resource strategies to promote broad-based implementation of tobacco-control EBIs in LMICs. This study builds on an intervention for schoolteachers, called the Tobacco Free Teachers, Tobacco Free Society (TFT-TFS) program, shown to be efficacious in increasing tobacco use cessation in a cluster-randomized trial. Teachers in India are an important channel for promoting tobacco control, given their roles as community leaders and role models. A critical next step in this research, which is our objective here, is to compare the implementation and effectiveness of the TFT-TFS program when delivered through in-person training verses a smartphone-based training model. Use of smartphones in educational settings is already pervasive in India offering a readily available, low-cost strategy for expanding training on the TFT-TFS program. By delivering TFT-TFS training through smartphones, the potential reach of the program can be multiplied over what can be achieved with in-person training. We will conduct a comparative effectiveness trial using a cluster-randomized design in which headmasters of schools in the Indian state of Madhya Pradesh will be randomly assigned to receive in-person training or training via smartphone for the TFT-TFS program. Once trained, headmasters in both groups will implement the TFT-TFS program within their schools. We will compare the training arms in terms of program implementation, effectiveness, cost, and reach. This Hybrid III study will be guided by the Consolidated Framework for Implementation Research and RE-AIM Framework; we will use mixed methods to analyze factors contributing to outcomes. Accordingly, our specific aims are to: (1) develop in-person and smartphone-based training models based on systematic assessment of contextual factors in Madhya Pradesh; (2) compare program implementation fidelity, effectiveness, and cost for the two training models; and (3) identify factors affecting program implementation after in-person vs. smartphone-based training using a mixed-methods design. This project is innovative by shifting the status quo from costly, time-intensive, in-person training to a smartphone-based training model to scale up tobacco control EBIs. The proposed research is significant because it introduces a new approach for reducing tobacco use and related deaths and demonstrates how training via smartphone can be applied to scaling other public health-related EBIs in resource-constrained areas.