Khetan Aditya, Hejjaji Vittal, Hughes Joel, Gupta Prashant, Barbhaya Dweep, Madan Mohan Sri Krishna, Josephson Richard A
Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, MO, USA.
Mhealth. 2019 Jun 11;5:15. doi: 10.21037/mhealth.2019.05.04. eCollection 2019.
Nearly 275 million individuals in India consume tobacco every day, with more than 1 million dying annually as a result. Few people in India have access to smoking cessation services, an essential component of combating tobacco use globally. We hypothesize that a strategy of systematic community health worker (CHW) based counseling that covers eligible people who smoke in a geographical area, combined with text messaging support, will result in improved quit rates.
The study is a cluster randomized controlled trial that will be conducted at 2 sites in India. Sixteen clusters will be randomized into either an intervention or control arm. A total of 560 smokers between the age of 18 and 70 will be recruited from their home through CHWs. Smokers at all stages of change will be offered the intervention, which is based on the transtheoretical model of change.
Pre-contemplative participants will be offered health education and motivational interviewing through CHWs. They will also be offered a low frequency form of text messaging, focused on health education and the benefits of quitting. Participants who are actively contemplating quitting smoking will be offered a more intensive intervention, with more frequent visits by CHWs and more intensive text messaging support. Contemplative participants will be encouraged to set a quit date, and all participants will be assessed periodically for stage of change to provide the appropriate intervention. Participants who set a quit date will be encouraged to use NRT to help with quitting. Control group participants are provided with brief smoking cessation advice only, at the start of the trial. The primary outcome will be self-reported abstinence for the past 14 days, biochemically verified by exhaled CO levels (cut-off 10 ppm) assessed at the end of 1 year of the intervention.
We will test whether a CHW-based intervention that incorporates motivational interviewing, text messaging and supportive counseling can prove effective in systematically helping smokers quit.
印度每天有近2.75亿人吸烟，每年有超过100万人因此死亡。在印度，很少有人能获得戒烟服务，而戒烟服务是全球控烟的重要组成部分。我们假设，基于社区卫生工作者（CHW）的系统咨询策略，覆盖某一地理区域内符合条件的吸烟者，并结合短信支持，将提高戒烟率。
该研究是一项整群随机对照试验，将在印度的2个地点进行。16个群组将被随机分为干预组或对照组。通过社区卫生工作者从家中招募总共560名年龄在18岁至70岁之间的吸烟者。将为处于所有改变阶段的吸烟者提供基于行为改变阶段理论模型的干预措施。
对处于前意向阶段的参与者，将通过社区卫生工作者提供健康教育和动机访谈。还将为他们提供低频短信，内容侧重于健康教育和戒烟的益处。对积极考虑戒烟的参与者，将提供更强化的干预措施，社区卫生工作者更频繁家访并提供更密集的短信支持。鼓励处于考虑阶段的参与者设定戒烟日期，并将定期评估所有参与者的改变阶段，以提供适当的干预措施。鼓励设定了戒烟日期的参与者使用尼古丁替代疗法来帮助戒烟。对照组参与者在试验开始时仅获得简短的戒烟建议。主要结局将是自我报告的过去14天内戒烟情况，在干预1年结束时通过呼出一氧化碳水平（临界值10 ppm）进行生化验证。
我们将测试基于社区卫生工作者的干预措施，结合动机访谈、短信和支持性咨询，是否能有效系统地帮助吸烟者戒烟。
