Treatment adherence in a lay health adviser intervention to treat tobacco dependence

Abstract

Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for >7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P=0.026) or have attempted quitting (85.0 versus 47.4%, P=0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence.

Efficacy of brief motivational interviewing on smoking cessation at tuberculosis clinics in Tshwane, South Africa: a randomized controlled trial

“…It follows from these results that smoking cessation is possible in TB patients with high HIV coinfection rates in a low‐ to medium‐income country such as South Africa. The second important finding is that smoking cessation services can be delivered by LHCWs—as demonstrated in only a few other studies —thus freeing valuable nurse time for more clinical tasks. This is important in the South African context, because TB patients often receive treatment for both TB and HIV.…”

Adherence to Tobacco Dependence Treatment Among HIV-Infected Smokers

“…Hood and colleagues have reported similar findings of higher participant responsiveness associated with abstinence in a rural female population (34). …”

“…Each measure was assessed by the study nurse using response options of: 1 = poor ; 2 = fair ; 3 = good ; and 4 = excellent , after concluding the telephone counseling call. The ratings for each of the three measures were averaged across visits and then summed to create a composite measure of responsiveness (34). The composite measure was dichotomized (> 10.5 and ≤ 10.5) to differentiate between participants who received an average of excellent ratings across all responsive measures from those who did not.…”

“…The composite measure was dichotomized (> 10.5 and ≤ 10.5) to differentiate between participants who received an average of excellent ratings across all responsive measures from those who did not. The cut-point of 10.5 was selected because this was the highest quartile of the composite measure, as reported by Hood and colleagues (34). …”

“…Although an intervention may be delivered as planned, patients do not always fully adhere to the prescribed intervention, thus limiting its efficacy. Participant responsiveness , a term referring to the level of engagement and enthusiasm a participant has for an intervention, may influence adherence and treatment outcomes (32–34). Antiretroviral therapy (ART) adherence has been widely examined among HIV-infected patients.…”