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

印度有2.67亿吸烟者和无烟烟草使用者， 戒烟工作对于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 从简单的建议干预到促进戒烟。这些干预措施可以在几个 由从业人员进行的会议记录，通常包括烟草使用的筛查，简短的咨询，以及转诊 服务然而，这些计划并不符合印度的需要，因为他们在这个时候：a）通常 来自高资源，西方环境，B）强调使用药物治疗，c）要求高度 有资质的员工。我们在这里关注的是任务转移，或者使用更容易接受 比专业人士更有资格。我们将通过培训和基于技术的 持续支持（使用“应用程序”和社交媒体渠道）。 目标：我们将调整和评估即将提供的戒烟简短建议干预的影响 在牙科诊所、肺结核诊所和非政府初级保健中心。该提案利用了 研究人员在癌症实施科学和行为干预方面的专业知识 预防和控制;孟买小组在培训从业人员使用简短建议方面的专业知识 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-实施研究将测试适应性简短建议的影响 委员会还将收集关于实施因素的试点数据。 因此，该研究借鉴了戒烟框架（5A）和实施科学 探索、准备、实施和维持框架（Exploration，Preparation，Implementation，and Sustainability framework）。该研究是有组织的 围绕三个目标。目标1将包括形成性研究，以支持现有简要建议的调整 干预措施。目标2支持随机对照试验，以评估适应性干预的有效性 并收集试点实施数据。目标3解决了让训练有素的从业者参与其中的机会 通过基于技术的支持，以持续的方式进行，重点是将这种参与与 程序交付。 创新和影响：这项研究的创新之处在于它关注每一步的可扩展性-从任务 转向选择初级卫生保健系统以外的从业人员，利用技术支持 从业者这些功能允许简单的、可扩展的简短建议干预，可以广泛用于 孟买以及其他低收入和中等收入国家的低资源环境，这是影响的关键。 这项研究的结果将支持在印度推广戒烟，并将建立适应性文献。 从高收入国家到中低收入国家的研究证据。

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.