Boeckmann, Melanie, Dogar, Omara orcid.org/0000-0002-7122-8403, Saeed, Saima et al. (5 more authors) (2021) Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh:contextual difference and opportunities. Tobacco induced diseases. 133054. ISSN 1617-9625
Abstract
INTRODUCTION Tobacco smoking among tuberculosis (TB) patients leads to poorer treatment outcomes. Smoking cessation support should be integrated into routine TB care. We measured healthcare providers' fidelity to a smoking cessation intervention integrated into routine TB care, in Bangladesh and Pakistan. We aimed to understand the role of providers and settings in the implementation of behavior support (BS) messages for TB and smoking cessation. METHODS The integrated BS intervention was implemented in TB clinics (24 public and 1 private). Cross-sectional data were collected on the fidelity of delivery of the BS intervention using a predefined fidelity index based on an existing validated method of measuring intervention fidelity. Audio-recordings of patient-provider BS sessions were coded using the fidelity index. Intervention fidelity was presented as the proportion of sessions that implemented BS messages. RESULTS A total of 96 sessions were conducted, 37 in Bangladesh and 59 in Pakistan. In public settings, TB medication advice was offered in 91.9% (95% CI: 78.7-97.2) of sessions in Bangladesh, and in 75.5% (95% CI: 62.4-85.1) of sessions in Pakistan; whilst it was offered in 83.3% (95% CI: 43.7-97.0) of sessions in the private setting in Pakistan. Patients' smoking status was assessed in 70.3% (95% CI: 54.2-82.5) of sessions in Bangladesh, and in 34.0% (95% CI: 22.7-47.4) of sessions in the public setting and in 66.7% (95% CI: 30.0-90.3) of sessions in the private setting in Pakistan. A quit date was set in 32.4% (95% CI: 19.6-48.5) of all sessions in Bangladesh, and in 33.3% (95% CI: 9.6-70.0) of all sessions in the public setting in Pakistan. CONCLUSIONS Fidelity to the intended delivery of the intervention was found to be high for TB-related messages but not for smoking cessation messages. Clinic contexts may play a mediating role in health workers' opportunities to deliver the intervention as planned.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Funding Information: The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. K. Siddiqi reports grants from European Commission H2020, and non-financial support from Aflofarm, during the conduct of the study. D. Kotz reports that he received an unrestricted grant from Pfizer in 2009 for an investigator-initiated trial on the effectiveness of practice nurse counselling and varenicline for smoking cessation in primary care (Dutch Trial Register NTR3067; DOI: 10.1111/add.13927). Funding Information: The TB & Tobacco project received funding from the European Union’s Horizon 2020 Research and Innovation programme, under Grant Agreement No. 680995. The European Commission is not responsible for the contents of this article. The authors have not entered into an agreement with the funder that may have limited their ability to complete the research as planned. The authors had full control of all primary data. The funding body had no role in design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Aflofarm Pharma Poland provided cytisine and placebo for the trial free of charge. The provider of cytisine had no role in designing or conducting the study, or in preparing this manuscript. Funding Information: The authors thank all the study participants who gave consent to have the behavior support session recorded. We acknowledge the important work of Maryam Noor, Saleem, Sheryar, Fariza Fieroze and Lina Silwa who coded the fidelity indices. Dominic Hart entered data for Bangladesh. We thank Helen Elsey and Sahil Warsi for giving input to first drafts of the fidelity index. The work was conducted while MB was based at the Medical Faculty of the Heinrich-Heine-University Duesseldorf, Institute of General Practice, Addiction Research and Epidemiology Unit. We would like to acknowledge Anne Readshaw for proofreading the manuscript. The TB & Tobacco project received funding from the European Union's Horizon 2020 Research and Innovation programme, under Grant Agreement No. 680995. The European Commission is not responsible for the contents of this article. The authors have not entered into an agreement with the funder that may have limited their ability to complete the research as planned. The authors had full control of all primary data. The funding body had no role in design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Aflofarm Pharma Poland provided cytisine and placebo for the trial free of charge. The provider of cytisine had no role in designing or conducting the study, or in preparing this manuscript. © 2021 Boeckmann M. et al. |
Keywords: | Behavior change,Primary health care,South Asia,Tobacco |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Health Sciences (York) The University of York > Faculty of Sciences (York) > Hull York Medical School (York) |
Funding Information: | Funder Grant number EUROPEAN COMMISSION 680995 EUROPEAN COMMISSION 680995 |
Depositing User: | Pure (York) |
Date Deposited: | 05 Feb 2021 11:00 |
Last Modified: | 02 Mar 2025 00:06 |
Published Version: | https://doi.org/10.18332/TID/133054 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.18332/TID/133054 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:170806 |
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Description: Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: Contextual differences and opportunities
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