Department of Psychology and Behavior Analysis, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, PR 445 Km 380, Londrina, PR, Brazil.
Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, MT 609, Birmingham, AL, USA.
Health Educ Res. 2019 Oct 1;34(5):505-520. doi: 10.1093/her/cyz025.
The purpose of this article is to describe the development of a theory-based, culturally and gender-relevant Community Health Worker (CWH)-led tobacco cessation intervention for low-income Brazilian women who augments the tobacco cessation program offered through the public health system using Intervention Mapping (IM). We began with the establishment of a network of representatives from different segments of society followed by comprehensive needs assessments. We then established a logical planning process that was guided by a theoretical framework (Social Cognitive Theory) and existing evidence-based tobacco cessation programs, taking into account socio-political context of a universal health care system. Given the gender-relevance of our intervention and the importance of social support in tobacco cessation among women, we chose an intervention that would be delivered within the public health system but augmented by CHWs that would be trained in behavior change by researchers. One of major advantages of utilizing IM was that decisions were made in a transparent and supportive manner with involvement of all stakeholders throughout the process. Despite the fact that this process is very taxing on researchers and the health care system as it takes time, resources and negotiation skills, it builds trust and promotes ownership which can assure sustainability.
本文旨在描述一种基于理论、具有文化和性别针对性的社区卫生工作者（CWH）主导的戒烟干预措施的发展，该干预措施针对的是巴西低收入女性，旨在增强公共卫生系统提供的戒烟计划。我们从建立一个代表不同社会群体的网络开始，然后进行全面的需求评估。接下来，我们建立了一个逻辑规划过程，该过程以理论框架（社会认知理论）和现有的基于证据的戒烟计划为指导，同时考虑到全民医疗保健系统的社会政治背景。考虑到我们干预措施的性别相关性以及社会支持在女性戒烟中的重要性，我们选择了一种干预措施，该措施将在公共卫生系统内实施，但由经过研究人员行为改变培训的社区卫生工作者来增强。利用干预映射（IM）的一个主要优势是，决策是在所有利益相关者的参与下以透明和支持的方式做出的，整个过程中都涉及到所有利益相关者。尽管这一过程对研究人员和医疗保健系统来说非常耗费精力，需要时间、资源和谈判技巧，但它建立了信任并促进了所有权，这可以确保可持续性。
