Abstract
BackgroundServices to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC.MethodsWe conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study.ResultsThe interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting).ConclusionsIn this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC.Trial registrationNCT02564653. Registered September 2015
Highlights
Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high
In this study, Consolidated Framework for Implementation Research (CFIR) provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a high-income country (HIC) to a LMIC
The CFIR framework provided a valuable structure for identifying, across four domains, interrelated facilitators and barriers to implementing a multicomponent intervention to increase adoption of tobacco use treatment guidelines. In applying this framework to the analysis, we found a number of potential facilitators including the high value that Community Health Centers (CHC) health care providers, staff, and village health worker (VHW) placed on the training component of the intervention and infrastructure and capacity building opportunities that participation in this program offered
Summary
Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. Treatment for tobacco use is not integrated into the health care delivery system, and patients are not routinely screened or offered evidence-based assistance [7]. This is in part due to a lack of training, funding, and infrastructure to support these activities and a lack cost effective strategies for implementing evidence-based approaches to treating tobacco use in the context of public health systems in LMICs [7,8,9,10]
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