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

背景：印度是世界第二大烟草消费国和第三大烟草生产国，也是与烟草有关的死亡率最高的国家之一。尽管有很好的证据表明戒烟干预措施的有效性，但它们并不完全适合印度的情况，因为它们侧重于吸烟烟草(而印度最常用的烟草是无烟烟草)，而且是由医务人员提供的(印度的资源有限)。因此，尽管烟草使用对公众健康的影响越来越大，但在那些想要戒烟的人中，只有很小一部分人得到了戒烟的帮助。在低资源环境下增加获得戒烟干预措施的一种方法是制定并扩大有效的、与背景相适应的但非资源密集型干预措施。我们的建议是开发并初步评估一种适合背景的干预措施，可以使用移动短信(印度一种廉价且容易获得的技术平台)来提供。因此，我们将克服人力资源障碍，利用移动电话技术向大量烟草使用者快速、低成本地提供戒烟干预措施。此外，我们将遵循一种系统的方法，在文化上调整干预措施，以提高烟草使用者的接受度和使用技术平台提供服务的可行性。目的/目标：ToQuit的总体目标是使用循证治疗开发流程来开发一种可使用移动电话技术提供的符合背景的戒烟干预措施，以克服在资源匮乏的情况下获得戒烟的障碍。ToQuit的具体目标是1)开发一套戒烟干预方案，利用移动电话技术在印度实施；2)检查在印度实施这种干预措施是否可接受和可行；3)进行初步测试，以确定干预措施是否有助于提高戒烟率；4)微调程序，在可行性随机对照试验范围内对干预措施的有效性进行最终测试。这些目标将通过一系列进程实现，包括制定干预措施，并利用包括吸烟者在内的一系列个人和团体的反馈对其进行调整；完善干预措施；测试其初步影响。这一治疗开发过程的成果将是一种在背景下可以接受和可行的戒烟干预方案，可以通过移动电话技术提供；并准备在更大的试验中进行测试。潜在的应用和好处：烟草使用是一个巨大且日益严重的问题，因为它会导致高水平的健康问题(如癌症)和死亡。我们希望通过使用移动电话(在印度和其他中低收入国家普遍拥有)，将过去仅由训练有素、费用高昂的医护人员面对面提供的帮助方式转变为更容易获得和更广泛使用的形式，从而帮助烟草使用者减少对他们造成的伤害。如果成功开发并被发现具有成本效益，我们的干预措施可以惠及LMIC的数百万人，并可能真正改变公共卫生领域的游戏规则。

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.