Abstract 366: A Combined Community Health Worker and Text Messaging-based Intervention for Smoking Cessation in India

Abstract

Background: Home-based Community Health Worker (CHW) led care is a mode of health promotion. We sought to evaluate the effectiveness of a CHW-led smoking cessation intervention, supplemented by text messages in a semi-urban region of India. Methods: We conducted a cluster randomized controlled trial (4/2018- 8/2019) in adult smokers residing in the eastern part of India. Participants in the intervention arm were offered CHW-led home visits that were focused on counseling. In addition, participants could choose to receive text messages. Both CHW counseling and test messages were adapted to the participant’s stage of change. The control group received brief education only. Our primary outcome was self-reported smoking cessation at the end of 12 months, verified by exhaled carbon monoxide levels. CHWs were interviewed at the end of the study. Results: A total of 234 (mean age 43±12.3, male 96.2%) participants were enrolled; 151 (64%) in the intervention arm and 83 (35.4%) in the control arm. At 12-months, 30 (19.8%) participants in the intervention arm and 12 (14.4%) in the control arm quit smoking (absolute risk difference=5.4%; OR 1.46, p = 0.71). There was large cluster-level heterogeneity in intervention uptake (figure). Highlights from the CHW interviews are described in the figure. Conclusion: CHW-led home-based counseling, supplemented by regular text messages, led to a slight increase in quit rates, especially among those exposed to a higher dose of the intervention. However, the difference in cessation rates was not statistically significant. Future studies should consider testing mobile application-based multimedia messaging options, as an enhanced supplement to CHW based counseling.