ToQuit: Development and preliminary evaluation of a technology assisted tobacco cessation intervention in India

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Context: India is the second largest consumer and third largest producer of tobacco in the world; and has one of the highest mortality rates related to tobacco. Although there is good evidence for the effectiveness of tobacco cessation interventions they are not completely suitable for the Indian context because they focus on smoked tobacco (whereas the most commonly used tobacco in India is smokeless tobacco) and are designed to be delivered by healthcare workers (a limited resource in India). Hence, despite the growing public health impact of tobacco use, only a very small proportion of those who want to discontinue tobacco use receive any help to quit. One way of increasing access to tobacco cessation interventions in low resource settings is to develop and scale up an effective and contextually appropriate but non-resource-intensive intervention. Our proposal is to develop and then preliminarily evaluate, a contextually appropriate intervention, that can be delivered using mobile text messaging (a cheap and easily available technological platform in India). Thus we will overcome the human resource barriers by using mobile phone technology to deliver tobacco cessation interventions to large numbers of tobacco users, quickly and at low cost. Furthermore, we will follow a systematic methodology to culturally adapt the intervention to increase acceptability by tobacco users and the feasibility of delivery using a technology platform.Aims/Objectives: The overall objective of ToQuit is to use evidence-based treatment development processes to develop a contextually appropriate tobacco cessation intervention that can be delivered using mobile phone technology in order to overcome barriers to access in low resource settings. The specific aims of ToQuit are to 1) Develop a tobacco cessation intervention package, to be delivered in India using mobile phone technology; 2) Examine if it is acceptable and feasible to deliver such an intervention in an Indian setting; 3) Conduct preliminary testing to see if the intervention helps in increasing tobacco quit rates; and 4) Fine-tune procedures for the definitive testing of the effectiveness of the intervention within a feasibility RCT. These aims will be achieved through a range of processes including development of the intervention and adapting it utilising feedback from a range of individuals and groups, including tobacco users; refinement of the intervention; and testing of its preliminary impact. The output of this treatment development process would be a contextually acceptable and feasible tobacco cessation intervention package that can be delivered through mobile phone technology; and which is ready to be tested in a larger trial. Potential applications and benefits: Tobacco use is a big and growing problem, because it leads to high levels of health problems (e.g. cancers) and deaths. We want to help tobacco users to reduce levels of harm caused to them, by transforming a way of helping which has in the past been delivered face-to-face, only by highly trained and expensive healthcare workers, into a much more accessible and widely available form, by using mobile phones (widely owned across India and other low and middle income countries [LMIC]). If successfully developed and found to be cost-effective, our intervention can reach millions of people across LMICs and could be a real game-changer in the field of public health.