Siddiqi Kamran, Dogar Omara, Rashid Rukhsana, Jackson Cath, Kellar Ian, O'Neill Nancy, Hassan Maryam, Ahmed Furqan, Irfan Muhammad, Thomson Heather, Khan Javaid
Department of Health Sciences, University of York, York, YO10 5DD, UK.
Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
BMC Public Health. 2016 Jun 10;16:501. doi: 10.1186/s12889-016-3177-8.
People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK.
We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine.
The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients' motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content - maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation.
We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.
南亚裔人群的无烟烟草（SLT）消费量占全球的四分之三以上；然而，关于SLT戒烟干预措施对该人群效果的证据却很少。南亚人使用高度成瘾且有害的SLT产品，这些产品具有很强的社会文化层面因素。我们设计了一种定制的行为改变干预措施（BCI）来帮助南亚人戒烟，然后在巴基斯坦和英国评估其可行性。
我们进行了两项文献综述，分别确定南亚人中SLT使用的决定因素以及可能改变这些因素的行为改变技术（BCTs）。反复的共识发展研讨会有助于为BCI选择有效的BCTs，并设计实施这些技术的活动和材料。我们在32名SLT使用者中对BCI进行了试点。所有BCI课程都进行了录音，并分析其对干预内容的依从性和互动质量（保真度指数）。分别对16名参与者和5名顾问进行深入访谈，评估实施BCI的可接受性和可行性。在6个月时通过唾液/尿液可替宁评估戒烟成功率。
BCI包括23项活动和一个支持这些活动的交互式图片资源。活动包括提高对SLT使用危害和戒烟益处的认识，增强客户的动机和自我效能感，以及制定应对触发因素、戒断症状和复吸（如果发生的话）的策略。槟榔块和古特卡是常见的SLT使用形式。巴基斯坦客户比英国客户对SLT的依赖程度更高。在32名参与者中，有4人在6个月时可替宁检测不到。每个地点在内容依从性方面的保真度得分在11.2至42.6之间——最高可达到的分数为44；在互动质量方面的得分在1.4至14之间——最高可达到的分数为14。对顾问的访谈强调需要对BCTs进行额外培训，整合尼古丁替代疗法并缩短戒烟前课程的时长。客户对健康信息持接受态度，但大多数人报告SLT使用量减少而非完全戒烟。
我们开发了一种基于理论的BCI，该干预措施具有一定的可接受性和可行性，保真度得分适中。现在需要在有效性试验中对其进行评估。
