Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: contextual difference and opportunities

TY - JOUR

T1 - Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh

T2 - contextual difference and opportunities

AU - Boeckmann, Melanie

AU - Dogar, Omara

AU - Saeed, Saima

AU - Majidulla, Arman

AU - Swami, Shilpi

AU - Khan, Amina

AU - Siddiqi, Kamran

AU - Kotz, Daniel

N1 - 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.

PY - 2021/4/1

Y1 - 2021/4/1

N2 - 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.

AB - 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.

KW - Behavior change

KW - Primary health care

KW - South Asia

KW - Tobacco

UR - http://www.scopus.com/inward/record.url?scp=85105129513&partnerID=8YFLogxK

U2 - 10.18332/TID/133054

DO - 10.18332/TID/133054

M3 - Article

AN - SCOPUS:85105129513

VL - 19

JO - Tobacco Induced Diseases

JF - Tobacco Induced Diseases

SN - 2070-7266

IS - April

M1 - 133054

ER -