Implementing tobacco use treatment in HIV clinics in Viet Nam

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ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-23-036. Cancer stigma among healthcare providers (HCPs) can impede and decrease the effective delivery and quality of cancer care, particularly in low-and-middle income country (LMIC) settings. Accurate, culturally-adapted assessments of cancer stigma in LMICs among HCP’s, who have been understudied to date, can thus inform efforts to mitigate this key barrier and contribute to clinicians’ efforts to effectively control and prevent cancer in these settings. The supplemental study, which is integrated into a three-arm tobacco cessation implementation-effectiveness randomized control trial among PLWH in Viet Nam, will develop a multi-component cancer stigma scale for clinicians (MCCSS-C), with an additional focus on lung cancer, for use among clinicians who treat patients who are at risk for cancer, and examine how cancer stigma is correlated with psychosocial and behavioral factors. First, a qualitative investigation will be conducted to understand how cancer stigma—and specifically lung cancer stigma—manifests among clinicians who treat patients who are at risk for cancer to inform the development of a cancer stigma measure for HCPs in Viet Nam. In this investigation, HCP’s attitudes and beliefs towards cancer patients (as well as those of their peer co-workers’) will be used to inductively identify new clinician domains of stigma towards people with cancer, with the main objective of exploring how the different components of HCP cancer stigma (i.e., perceived community stigma, negative attitudes and emotions, enacted co-worker stigma, and health facility policies/work environment) are perceived among Vietnamese HCP’s. Following selection of the final items to comprise each dimension-specific stigma subscale, the MCCSS-C will undergo initial psychometric evaluation. The revised MCCSS-C (both the “general cancer stigma” and “lung cancer stigma” versions) will be administered to 30 new HCPs to assess both its initial psychometric properties and the relationships between different cancer stigma dimensions and select psychosocial factors. Little is known about how cancer stigma may manifest in HCPs whose patients are at higher risk of developing cancer, specifically in LMICs, and key insights into this harmful social dynamic along with culturally-salient expressions of stigma will be elucidated in the process of developing our measure. An evaluation of cancer stigma among clinicians who treat people with HIV will act as a key step towards developing a future scale that will generalize to all clinicians in Vietnam and have applicability to clinicians in LMICs overall.