Barriers and facilitators to expanding the role of community health workers to include smoking cessation services in Vietnam: a qualitative analysis

Abstract

BackgroundDespite high smoking rates, cessation services are largely unavailable in Vietnam. This study explored attitudes and beliefs of community health workers (CHWs) towards expanding their role to include delivering tobacco use treatment (TUT), and potential barriers and facilitators associated with implementing a strategy in which health centers would refer patients to CHWs for cessation services.MethodsWe conducted four focus groups with 29 CHWs recruited from four district community health centers (CHCs) in Hanoi, Vietnam.ResultsParticipants supported expanding their role saying that it fit well with their current responsibilities. They further endorsed the feasibility of serving as a referral resource for providers in local CHCs expressing the belief that CHWs were “more suitable than their clinical colleagues” to offer cessation assistance. The most frequently cited barrier to routinely offering cessation services was that despite enacting a National Tobacco Control Action plan, cessation is not one of the national prevention priorities. As a result, CHWs have not been “assigned” to help smokers quit by the Ministry of Health. Additional barriers included lack of training and time constraints.ConclusionFocus groups suggest that implementing a systems-level intervention that allows providers to refer smokers to CHWs is a promising model for extending the treatment of tobacco use beyond primary care settings and increasing access to smoking cessation services in Vietnam. There is a need to test the cost-effectiveness of this and other strategies for implementing TUT guidelines to support and inform national tobacco control policies in Vietnam and other low-and middle-income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0606-1) contains supplementary material, which is available to authorized users.

Tobacco cessation in Vietnam: Exploring the role of village health workers

“…Current practice patterns related to tobacco use treatment were assessed using a validated tool that included the following questions: In the past month how many patients did you: 1) ask about tobacco use, 2) advise to quit, and 3) provide assistance (i.e., brief counseling). Using a 5-point likert scale responses included none, few, half, more than half, and all or most (Shelley et al, 2014). …”

“…The survey was translated from the English version to the Vietnamese version and then back-translated to English (Shelley et al, 2014). …”

“…However, there is strong evidence that counseling, delivered by a range of health care providers, can significantly increase the likelihood of smoking abstinence (Fiore et al, 2009; West et al, 2015). Barriers to implementing Article 14 also include a lack of training, funding, and infrastructure to support recommended activities (McRobbie, Raw, Chan, 2013; Raw, Regan, Rigotti, & McNeill, 2009; Kruse et al, 2016; Shelley et al, 2014). Finally, there is a lack of research to inform cost effective strategies for adapting evidence-based approaches to treating tobacco use in the context of public health systems in LMICs.…”

“…However, qualitative research conducted with VHWs in Vietnam suggested the feasibility of a team approach to treating tobacco use that would allow providers to refer smokers to VHWs for further counseling and assistance, and thus extend treatment beyond primary care settings and increase access to evidence-based care (Shelley, Nguyen, Pham, VanDevanter, & Nguyen, 2014). The aim of this paper is to present data from surveys of VHWs to further characterize their attitudes towards treating tobacco use, current practice patterns and barriers and facilitators to integrating cessation services into their current responsibilities.…”

Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges

“…Together with cessation services at health care centers, quit lines can be described as an official system that is easy to access by smokers to get advices or support to quit smoking. Some case studies of quit line that support smokers have been conducted in Vietnam recently (Shelley et al, 2014). Pharmacological therapy to support smoking cessation includes two main types of products which are nicotine replacement therapy -NRT (nicotine gum, lozenge, and spray) and pharmacotherapy (Varenicline, Bupropion).…”