Integration of tobacco cessation and tuberculosis management by NGOs in urban India: a mixed-methods study

Gupte, Himanshu; Zachariah, Rony; Sagili, Karuna D.; Thawal, Vaibhav; Chaudhuri, Leni; Verma, Harshit; Dongre, Amol R; Malekar, A; Rigotti, Nancy A.

doi:10.5588/pha.17.0085

Cited by 12 publications

(13 citation statements)

References 18 publications

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“…The most frequently described facilitators that foster smoking cessation/TDT in TB patients were repeated brief interventions (including motivation and brochures) 15 - 17 , 28 , 31 followed by personalized behavioural counselling incorporated into routine TB services 24 , 35 , 43 , 46 . The SCIDOT project showed that adding smoking cessation intervention (SCI) to conventional DOTS increased biochemically validated 6-month abstinence 24 .…”

Section: Resultsmentioning

confidence: 99%

“…*** *** Living in urban areas, office jobs, being single significantly increased the intention to quit smoking 22 Combined interventions 13,19,20 Brief, but repeated interventions, motivation, brochures [15][16][17]28,31 Tobacco-free healthcare facilities 25 Time from waking to first cigarette of >30 min, routine screening for smoking, having a smoke-free home and display of 'no smoking' sign at home, regular reminders and encouragement of by family members to quit smoking 25 Willingness to quit -higher in those with previous attempt(s) in the past year 32 Incorporating of training in brief advice into existing training of DOTS providers 33 Personalized behavioural counselling incorporated into routine TB services 24,35,43,46 High level of awareness regarding smoking risk for health 36 Multiple risk behaviour interventions 37 Repeated tobacco use intervention follow-up at a minimum of 6 months after end of TB treatment 30,43 Providing intervention not only at a health facility but also on a daily basis at community level by health volunteers 46…”

Section: Facilitators Of Smoking Cessation/tdt In Patients With Tb Ofmentioning

confidence: 99%

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A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries

Zvolská¹,

Pánková²,

Nohavová³

et al. 2020

Tob. Induc. Dis.

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INTRODUCTION Smoking is a substantial cause of premature death in patients with tuberculosis (TB), particularly in low-and middle-income countries (LMICs) with high TB prevalence. The importance of incorporating smoking cessation and tobacco-dependence treatment (TDT) into TB care is highlighted in the most recent TB care guidelines. Our objective is to identify the likely key facilitators of and barriers to smoking cessation for patients with TB in LMICs. METHODS A systematic search of studies with English-language abstracts published between January 2000 and May 2019 was undertaken in the EMBASE, MEDLINE, EBSCO, ProQuest, Cochrane and Web of Science databases. Data extraction was followed by study-quality assessment and a descriptive and narrative synthesis of findings. RESULTS Out of 267 potentially eligible articles, 36 satisfied the inclusion criteria. Methodological quality of non-randomized studies was variable; low risk of bias was assessed in most randomized controlled studies. Identified facilitators included brief, repeated interventions, personalized behavioural counselling, offer of pharmacotherapy, smoke-free homes and a reasonable awareness of smoking-associated risks. Barriers included craving for a cigarette, low level of education, unemployment, easy access to tobacco in the hospital setting, lack of knowledge about quit strategies, and limited space and privacy at the clinics. Findings show that the risk of smoking relapse could be reduced through consistent follow-up upon completion of TB therapy and receiving a disease-specific smoking cessation message. CONCLUSIONS Raising awareness of smoking-related health risks in patients with TB and implementing guideline-recommended standardized TDT within national TB programmes could increase smoking cessation rates in this high-risk population.

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Section: Resultsmentioning

confidence: 99%

Section: Facilitators Of Smoking Cessation/tdt In Patients With Tb Ofmentioning

confidence: 99%

A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries

Zvolská¹,

Pánková²,

Nohavová³

et al. 2020

Tob. Induc. Dis.

View full text Add to dashboard Cite

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“…These findings on the importance of images are in line with prior research on BCT-based cessation interventions in South Asia. 16–18 Patients were not opposed to being approached about their smoking habit, although health workers expressed concerns that women might not admit to tobacco use and that asking about tobacco use was a sensitive issue. 12 There is a need for more in-depth research on what role stigma really plays and whether gender remains a determinant for smoking even among younger generations of women in Bangladesh and Pakistan.…”

Section: Discussionmentioning

confidence: 99%

“…To address these challenges, support from National TB Programmes and clinic heads to reduce documentation burden and ensure regular refresher training seems to be essential, as has been shown elsewhere. 18…”

Section: Discussionmentioning

confidence: 99%

Health worker and patient views on implementation of smoking cessation in routine tuberculosis care

Boeckmann

Warsi

Noor³

et al. 2019

npj Prim. Care Respir. Med.

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Smoking worsens tuberculosis (TB) outcomes. Persons with TB who smoke can benefit from smoking cessation. We report findings of a multi-country qualitative process evaluation assessing barriers and facilitators to implementation of smoking cessation behaviour support in TB clinics in Bangladesh and Pakistan. We conducted semi-structured qualitative interviews at five case study clinics with 35 patients and 8 health workers over a period of 11 months (2017–2018) at different time points during the intervention implementation phase. Interviews were conducted by trained researchers in the native languages, audio-recorded, transcribed into English and analysed using a combined deductive–inductive approach guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. All patients report willingness to quit smoking and recent quit attempts. Individuals’ main motivations to quit are their health and the need to financially provide for a family. Behavioural regulation such as avoiding exposure to cigarettes and social influences from friends, family and colleagues are main themes of the interviews. Most male patients do not feel shy admitting to smoking, for the sole female patient interviewee stigma was an issue. Health workers report structural characteristics such as high workload and limited time per patient as primary barriers to offering behavioural support. Self-efficacy to discuss tobacco use with women varies by health worker. Systemic barriers to implementation such as staff workload and socio-cultural barriers to cessation like gender relations, stigma or social influences should be dealt with creatively to optimize the behaviour support for sustainability and scale-up.

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“…[ 28 ] Studies in India have also found the integration of tobacco cessation services provided by DOTs providers in routine care to be feasible and effective. [ 29 30 31 ] Regular monitoring of TB patients of tobacco use and nicotine dependence can also be tried to formulate a tailored tobacco cessation plan for patients. One of the limitations of the study was the assessment of tobacco use which was self-reported by the patients; this could have led to an underestimation of the prevalence of tobacco use among TB patients due to the social desirability bias.…”

Section: Discussionmentioning

confidence: 99%

Tobacco use and nicotine dependence among newly diagnosed pulmonary tuberculosis patients in Ballabgarh tuberculosis unit, Haryana

Kumar

Kant

Chandra

et al. 2020

J Family Med Prim Care

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Introduction: This study was conducted to estimate the burden of tobacco use and nicotine dependence among newly diagnosed pulmonary tuberculosis patients to help inform effective implementation of tobacco cessation strategies among tuberculosis patients to improve treatment outcomes. Materials and Methods: This was a cross-sectional study conducted among 211 consecutive newly diagnosed pulmonary tuberculosis patients between July 2018 till January 2019 at Ballabgarh tuberculosis unit (TU) in Faridabad district of Haryana, India. All participants were administered a pre-tested questionnaire to assess tobacco use and the Fagerstrom test for nicotine dependence (FTND) to assess nicotine dependence. Current tobacco users were defined as those who smoked in the past 7 days. Nicotine dependence was classified as low, moderate, or high for the FTND score of 0-3, 4-6, and 7-10, respectively. Results: Majority of the participants (71.1%) were male, aged 26–50 years (45.5%), and married (65.4%). Fifty (23.7%, CI: 18.0–29.4) participants were currently using tobacco; 29 (13.7%, CI: 9.1–18.4) reported smoking tobacco while 23 (10.9%, CI: 6.7–15.1) reported using smokeless tobacco. In the last month, the proportion of patients who attempted to quit smoking and smokeless tobacco was 31% and 26.1%, respectively. 86.2% of the smokers and 69.6% smokeless tobacco users reported moderate to a high level of nicotine dependence. Conclusion: High prevalence of tobacco use, a higher level of nicotine dependence and inability to quit despite an attempt among a large number of tuberculosis patients, necessitates the inclusion of routine tobacco cessation advice and nicotine replacement therapy in tuberculosis care.

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Integration of tobacco cessation and tuberculosis management by NGOs in urban India: a mixed-methods study

Cited by 12 publications

References 18 publications

A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries

A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries

Health worker and patient views on implementation of smoking cessation in routine tuberculosis care

Tobacco use and nicotine dependence among newly diagnosed pulmonary tuberculosis patients in Ballabgarh tuberculosis unit, Haryana

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