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

扩大印度的烟草控制：比较智能手机与面对面培训，以实施循证干预措施，减少学校教师的烟草使用

• 批准号: 10208346
• 负责人: Eve M Nagler
• 金额: $ 34.69万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10208346
• 关键词: Address; Adoption; Adult; Affect; Area; Cancer Control; Car Phone; Cellular Phone; Cessation of life; Characteristics; Cluster randomized trial; Communities; Consolidated Framework for Implementation Research; Data; Education; Effectiveness; Ensure; Evidence based intervention; Goals; Hybrids; India; Individual; Intervention; Interview; Learning; Logistics; Methods; Mission; Modeling; Outcome; Penetration; Persons; Population; Public Health; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Resources; Role; Rural; Schools; Smoke; Smokeless; Societies; Structure; Technology; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Training; Variant; Work; arm; base; comparative effectiveness study; comparative effectiveness trial; contextual factors; cost; design; experience; flexibility; implementation cost; implementation fidelity; implementation framework; innovation; insight; low and middle-income countries; mortality; novel strategies; portability; primary outcome; programs; public policy on tobacco; reduce tobacco use; role model; rural area; scale up; secondary outcome; smartphone Application; teacher; tobacco control; tobacco products; tobacco-free; virtual

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.

烟草相关死亡在低收入和中等收入国家（LMIC）迅速上升。在 仅在印度，烟草使用每年就造成120多万人死亡。减少这些死亡将需要 大规模实施促进戒烟的循证干预措施。 然而，由于进行面对面培训以实施 烟草控制的EBI需要新的模式，可以更广泛，灵活和低成本地实施。 在这种强有力的烟草控制EBI得到实施和扩大之前，与烟草有关的死亡率将继续上升， 上升.我们的长期目标是确定有效的、低资源的战略，以促进基础广泛的执行 低收入国家烟草控制的EBI。这项研究建立在对学校教师的干预基础上，称为烟草 免费教师、无烟社会（TFT-TFS）计划在增加烟草使用方面显示出有效性 在一项随机分组的试验中，印度的教师是宣传烟草的重要渠道 控制，鉴于他们作为社区领袖和榜样的作用。这项研究的关键下一步是， 这里的目的是比较TFT-TFS计划在交付时的实施情况和有效性 通过面对面的培训和基于智能手机的培训模式。智能手机在教育领域的应用 在印度，这种环境已经很普遍，提供了一种现成的、低成本的战略， TFT-TFS程序。通过智能手机提供TFT-TFS培训， 可以成倍地增加通过亲自培训所能达到的效果。我们将进行比较 有效性试验采用了随机分组设计，其中校长的学校在印度的状态， 中央邦将被随机分配接受面对面培训或通过智能手机培训， TFT-TFS程序。一旦接受培训，两组的校长将在各自的工作范围内实施TFT-TFS计划。 学校我们将从项目实施、有效性、成本和覆盖面等方面对培训机构进行比较。 这项混合III研究将以实施研究和RE-AIM综合框架为指导 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 目标是：（1）在系统评估的基础上，开发面对面和基于智能手机的培训模式， 背景因素在中央邦;（2）比较计划实施的保真度，有效性和成本， 这两种培训模式;（3）确定影响计划实施的因素后，在人与 使用混合方法设计的基于智能手机的培训。这个项目通过改变现状而具有创新性 从昂贵、耗时的面对面培训到基于智能手机的培训模式， 控制EBI。这项拟议中的研究意义重大，因为它引入了一种减少烟草的新方法 使用和相关的死亡，并演示了如何通过智能手机培训可以应用于扩大其他公共 在资源有限的地区与卫生有关的基础设施投资。