Salloum Ramzi G, Romani Maya, Bteddini Dima S, El-Jardali Fadi, Lee Ji-Hyun, Theis Ryan, LeLaurin Jennifer H, Hamadeh Randa, Osman Mona, Abla Ruba, Khaywa Jihan, Ward Kenneth D, Shelley Donna, Nakkash Rima
Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA.
Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Implement Sci Commun. 2023 Jun 26;4(1):72. doi: 10.1186/s43058-023-00456-w.
Tobacco use remains the leading cause of preventable disease, disability, and death in the world. Lebanon has an exceptionally high tobacco use burden. The World Health Organization endorses smoking cessation advice integrated into primary care settings as well as easily accessible and free phone-based counseling and low-cost pharmacotherapy as standard of practice for population-level tobacco dependence treatment. Although these interventions can increase access to tobacco treatment and are highly cost-effective compared with other interventions, their evidence base comes primarily from high-income countries, and they have rarely been evaluated in low- and middle-income countries. Recommended interventions are not integrated as a routine part of primary care in Lebanon, as in other low-resource settings. Addressing this evidence-to-practice gap requires research on multi-level interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings.
The objective of this study is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in primary healthcare centers within the Lebanese National Primary Healthcare Network. We will adapt and tailor an existing in-person smoking cessation program to deliver phone-based counseling to smokers in Lebanon. We will then conduct a three-arm group-randomized trial of 1500 patients across 24 clinics comparing (1) ask about tobacco use; advise to quit; assist with brief counseling (AAA) as standard care; (2) ask; advise; connect to phone-based counseling (AAC); and (3) AAC + nicotine replacement therapy (NRT). We will also evaluate the implementation process to measure factors that influence implementation. Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. This study will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, supported by Proctor's framework for implementation outcomes.
The project addresses the evidence-to-practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually tailored multi-level interventions while optimizing implementation success and sustainability. This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings, thereby reducing tobacco-related morbidity and mortality.
ClinicalTrials.gov, NCT05628389, Registered 16 November 2022.
烟草使用仍是全球可预防疾病、残疾和死亡的主要原因。黎巴嫩的烟草使用负担格外沉重。世界卫生组织认可将戒烟建议纳入初级保健机构，以及提供方便获取的免费电话咨询和低成本药物治疗，作为针对人群层面烟草依赖治疗的标准做法。尽管这些干预措施能够增加烟草治疗的可及性，且与其他干预措施相比具有很高的成本效益，但其证据基础主要来自高收入国家，在低收入和中等收入国家很少得到评估。与其他资源匮乏地区一样，黎巴嫩并未将推荐的干预措施作为初级保健的常规组成部分。解决这一证据与实践之间的差距，需要研究在资源匮乏地区实施综合、可扩展且可持续的戒烟治疗的多层次干预措施和背景因素。
本研究的目的是评估在黎巴嫩国家初级保健网络内的初级保健中心实施循证烟草治疗的有前景的多成分干预措施的相对有效性。我们将调整并定制现有的面对面戒烟项目，为黎巴嫩的吸烟者提供电话咨询。然后，我们将在24家诊所对1500名患者进行三臂组随机试验，比较：（1）询问烟草使用情况；建议戒烟；提供简短咨询协助（AAA）作为标准护理；（2）询问；建议；连接电话咨询（AAC）；以及（3）AAC+尼古丁替代疗法（NRT）。我们还将评估实施过程，以衡量影响实施的因素。我们的核心假设是，将患者连接到提供NRT的电话咨询是最有效的选择。本研究将以探索、准备、实施、维持（EPIS）框架为指导，并得到普罗克特实施结果框架的支持。
该项目通过开发和测试因地制宜的多层次干预措施，同时优化实施成功率和可持续性，解决了资源匮乏地区在提供烟草依赖治疗方面证据与实践之间的差距。这项研究具有重要意义，因为它有可能指导在资源匮乏地区大规模采用具有成本效益的策略来实施烟草依赖治疗，从而降低与烟草相关的发病率和死亡率。
ClinicalTrials.gov，NCT05628389，于2022年11月16日注册。
