Adapting and evaluating a brief advice tobacco intervention in high-reach, low-resource settings in India

项目摘要：背景：印度有2.67亿吸烟和无烟烟草用户，制造 戒烟努力对解决与烟草有关的癌症和疾病至关重要。一个重要的机会来了 从简短的建议干预到促进戒烟。这些干预措施可以在几个小时内完成 由从业者记录的时间，通常包括烟草使用筛查、简短咨询和转介 服务。然而，这些方案目前不能满足印度的需要，因为它们：a)通常 来自资源丰富的西方环境，b)强调药物治疗的使用，c)要求很高 有资质的员工。我们在这里关注的是任务转移，即使用资历较低的员工，他们更容易完成 比具有高资质的专业人士更有能力。我们将通过培训和基于技术的支持来支持他们 持续支持(使用“应用程序”和社交媒体渠道)。 目标：我们将调整和评估一项简短的戒烟建议干预措施的影响。 在牙科诊所、结核病诊所和非政府初级卫生中心。这项提议充分利用了 研究人员在实施科学和专注于癌症的行为干预方面的专业知识 预防和控制；孟买团队在培训从业者方面的专业知识使用简短的建议 计划；以及技术合作伙伴在开发应用程序以支持卫生工作者实施 程序。 方法：这项混合有效性-实施研究将测试经过调整的简短建议的影响 该中心还将对戒烟结果进行干预，并将收集有关实施因素的试点数据。 因此，这项研究借鉴了戒烟框架(5A)和实施科学 框架(探索、准备、实施和可持续框架)。这项研究是有组织的 围绕三个目标。目标1将包括形成性研究，以支持对现有简短建议的适应 干预措施。AIM 2支持一项随机对照试验，以评估适应性干预的有效性 并收集试点实施数据。AIM 3提供了让训练有素的从业者参与 通过以技术为基础的支持持续进行，重点是将这种接触与 程序交付。 创新和影响：这项研究具有创新性，因为它关注从任务开始的每一步的可扩展性 转向选择初级医疗保健系统之外的医生，并使用技术支持 从业者。这些功能允许简单、可扩展的简短建议干预，可广泛用于 孟买以及其他低收入和中等收入国家的低资源环境，这是产生影响的关键。 这项研究的发现将支持印度的可扩展戒烟，并将建立适应的文献 研究从高收入国家到低收入和中等收入国家的证据。

Project Summary: Background: India has 267 million users of smoked and smokeless tobacco, making cessation efforts critical for addressing tobacco-related cancers and diseases. An important opportunity comes from brief advice interventions to promote tobacco cessation. These interventions can be delivered in a few minutes by practitioners and typically include screening for tobacco use, brief counseling, and referral to services. However, these programs do not meet the needs of the Indian context at this time as they: a) typically come from high-resource, Western settings, b) emphasize the use of pharmacotherapy, and c) require highly credentialed staff. We focus here on task-shifting, or using less credentialed workers who are more readily available than highly credentialed professionals. We will support them through training and technology-based ongoing supports (using an “app” and a social media channel). Goal: We will adapt and evaluate the impact of a brief advice intervention for tobacco cessation to be delivered in dental clinics, tuberculosis clinics, and non-governmental primary health centers. This proposal leverages investigators' expertise with implementation science and behavioral interventions focused on cancer prevention and control; the Mumbai-based team's expertise in training practitioners to use brief advice programs; and the technology partner's expertise in developing apps to support health workers implement programs. Methods: This hybrid effectiveness-implementation study will test the impact of an adapted brief advice intervention on tobacco cessation outcomes and will also collect pilot data regarding implementation factors. Accordingly, the study draws on a tobacco cessation framework (5 A's) and an implementation science framework (the Exploration, Preparation, Implementation, and Sustainment framework). The study is organized around three aims. Aim 1 will include formative research to support adaptation of existing brief advice interventions. Aim 2 supports a randomized controlled trial to assess effectiveness of the adapted intervention and gather pilot implementation data. Aim 3 addresses the opportunity to engage trained practitioners in an ongoing manner through technology-based supports, with an emphasis on linking such engagement to program delivery. Innovations and impact: This study is innovative in that it focuses on scaleability at every step – from task shifting to selecting practitioners outside the primary healthcare system, to using technology to support practitioners. These features allow for a simple, scaleable brief advice intervention that can be used widely in low-resource settings in Mumbai as well as other low- and middle-income countries, which is key for impact. Findings from the study will support scalable tobacco cessation in India and will build the literature on adapting research evidence from high-income countries to lower- and middle-income countries.