衡量在巴基斯坦和孟加拉国将新的戒烟干预措施纳入常规结核病护理的实施保真度：背景差异与机遇

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

作者信息

Boeckmann Melanie, Dogar Omara, Saeed Saima, Majidulla Arman, Swami Shilpi, Khan Amina, Siddiqi Kamran, Kotz Daniel

机构信息

School of Public Health, Bielefeld University, Bielefeld, Germany.

Department of Health Sciences, University of York, York, United Kingdom.

出版信息

Tob Induc Dis. 2021 Apr 8;19:24. doi: 10.18332/tid/133054. eCollection 2021.

DOI:10.18332/tid/133054

PMID:33841063

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8029647/

Abstract

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.

TRIAL REGISTRATION

International Standard Randomized Clinical Trial Number (ISRCTN43811467). Registered 23 March 2016, https://doi.org/10.1186/ISRCTN43811467.

摘要

引言

结核病（TB）患者吸烟会导致治疗效果较差。戒烟支持应纳入常规结核病护理中。我们在孟加拉国和巴基斯坦测量了医疗服务提供者对纳入常规结核病护理的戒烟干预措施的依从性。我们旨在了解提供者和环境在实施针对结核病和戒烟的行为支持（BS）信息方面的作用。

方法

在结核病诊所（24家公立和1家私立）实施了综合BS干预措施。使用基于现有经过验证的测量干预依从性方法的预定义依从性指数，收集了关于BS干预措施实施依从性的横断面数据。使用依从性指数对患者与提供者的BS会话录音进行编码。干预依从性以实施BS信息的会话比例表示。

结果

共进行了96次会话，其中孟加拉国37次，巴基斯坦59次。在公共环境中，孟加拉国91.9%（95%CI：78.7-97.2）的会话提供了结核病药物建议，巴基斯坦为75.5%（95%CI：62.4-85.1）；而在巴基斯坦的私立环境中，83.3%（95%CI：43.7-97.0）的会话提供了该建议。孟加拉国70.3%（95%CI：54.2-82.5）的会话评估了患者的吸烟状况，在巴基斯坦，公立环境中这一比例为34.0%（95%CI：22.7-47.4），私立环境中为66.7%（95%CI：30.0-90.3）。孟加拉国所有会话中有32.4%（95%CI：19.6-48.5）设定了戒烟日期，在巴基斯坦公立环境的所有会话中这一比例为33.3%（95%CI：9.6-70.0）。