Cluster on Chronic conditions and public policies, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
BMJ Glob Health. 2022 Nov;7(11). doi: 10.1136/bmjgh-2022-008859.
The burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, diversity in outcomes of widely implemented policies and the defining role of the context, we conducted a realist synthesis to examine tobacco control policy implementation in LMICs.
We conducted a systematic realist literature review to test an initial programme theory developed by the research team. We searched EBSCOHost and Web of Science, containing 19 databases. We included studies on implementation of government tobacco control policies in LMICs.
We included 47 studies that described several contextual factors, mechanisms and outcomes related to implementing tobacco control policies to varying depth. Our initial programme theory identified three overarching strategies: awareness, enforcement, and review systems involved in implementation. The refined programme theory identifies the plausible mechanisms through which these strategies could work. We found 30 mechanisms that could lead to varying implementation outcomes including normalisation of smoking in public places, stigmatisation of the smoker, citizen participation in the programme, fear of public opposition, feeling of kinship among violators and the rest of the community, empowerment of authorised officials, friction among different agencies, group identity among staff, shared learning, manipulation, intimidation and feeling left out in the policy-making process.
The synthesis provides an overview of the interplay of several contextual factors and mechanisms leading to varied implementation outcomes in LMICs. Decision-makers and other actors may benefit from examining the role of one or more of these mechanisms in their particular contexts to improve programme implementation. Further research into specific tobacco control policies and testing particular mechanisms will help deepen our understanding of tobacco control implementation in LMICs.
CRD42020191541.
在低收入和中等收入国家（LMICs），烟草使用的负担不成比例地高。关于在这些环境中实施烟草控制政策的有效性，理论研究很少。鉴于烟草控制政策实施的复杂性、广泛实施的政策结果的多样性以及背景的决定性作用，我们进行了一项真实主义综合研究，以考察 LMICs 中的烟草控制政策实施情况。
我们进行了系统的真实主义文献综述，以检验研究团队最初制定的方案理论。我们在 EBSCOHost 和 Web of Science 中进行了搜索，其中包含 19 个数据库。我们纳入了关于 LMICs 政府烟草控制政策实施的研究。
我们纳入了 47 项研究，这些研究详细描述了与实施烟草控制政策相关的几个背景因素、机制和结果。我们最初的方案理论确定了三个总体战略：实施过程中涉及的意识、执行和审查系统。经过精炼的方案理论确定了这些战略可能发挥作用的合理机制。我们发现了 30 种机制，这些机制可能导致不同的实施结果，包括公共场所吸烟正常化、吸烟者被污名化、公民参与该计划、害怕公众反对、违规者和社区其他成员之间的亲情、授权官员的赋权、不同机构之间的摩擦、员工之间的群体认同、共同学习、操纵、恐吓和在决策过程中被边缘化。
该综合研究提供了一个概述，说明了在 LMICs 中，几个背景因素和机制相互作用，导致了不同的实施结果。决策者和其他利益相关者可以从检查这些机制在其特定背景下的作用中受益，以改善项目实施。对特定烟草控制政策的进一步研究和对特定机制的测试将有助于加深我们对 LMICs 中烟草控制实施的理解。
PROSPERO 注册号：CRD42020191541。
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