Effectiveness of a Multicomponent Strategy for Implementing Guidelines for Treating Tobacco Use in Viet Nam Commune Health Centers

Abstract

Background: Strategies are needed to increase adoption and implementation of evidence-based guidelines for treating tobacco use in health care systems in low- and middle-income countries (LMICs). Methods: We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing tobacco dependence treatment (TDT) guidelines in community health centers (n=26) in Viet Nam. Arm 1 included training and a tool kit that included provider materials (e.g. reminder and documentation system) to promote and support delivery of the 4As (Ask about tobacco use, Assess readiness to quit, Advise to quit, Assist with brief counseling). Arm 2 included Arm 1 components plus a system to refer tobacco users to a trained village health worker (VHW) for 3 sessions of in-person cessation counseling. The primary outcome was provider adoption of TDT guidelines defined as delivery of the 4As and rates of referral to the VHW in Arm 2 at the end of the intervention period (12 months). Findings: Adoption of each of the 4As increased significantly across both study arms (all p<.001). In Arm 2 sites, 41% of smokers were referred to a VHW for additional counseling. Waterpipe users were less likely to receive support for quitting compared with dual and cigarette only smokers. Provider reported self-efficacy, attitudes and norms related to treating tobacco dependence and confidence to deliver TDT increased significantly compared with baseline. Interpretation. The study demonstrated the effectiveness of a multicomponent strategy for implementing evidence-based TDT that was adapted to the public health care delivery system context in Viet Nam. The integrated model, which bridged provider-delivered screening and brief counseling with opportunities for more in depth VHW-driven treatment, may optimize access and outcomes and offers a potentially scalable model for increasing access to treatment in health care systems like Viet Nam. Funding Statement: US National Cancer Institute Declaration of Interests: The authors have no conflicts of interest to report. Ethics Approval Statement: This research was approved by the New York University School of Medicine and Institute for Social and Medical Studies Institutional Review Boards.