Exploratory randomised trial of face-to-face and mobile phone counselling against usual care for tobacco cessation in Indian primary care: a randomised controlled trial protocol for project CERTAIN

Comparison of quit rates among exclusive cigarette smokers at Tobacco Control Center in Qatar: telephone versus face-to-face consultation

BACKGROUND

During the coronavirus 2019 pandemic, smoking cessation services were delivered by telephone instead of routine face-to-face care. The objective of this study was to (1) determine if telephone care increases smoking quit rate compared to face-to-face intervention and (2) investigate factors associated with successful smoking cessation.

METHODS

A retrospective study design was utilized. Random selection of patients from two groups (face-to-face care and telephone care) that completed 3 follow-up sessions in Tobacco Control Center in Hamad Medical Corporation in Qatar was conducted from April 2020 to September 2021. Quit rates were compared at 4-week, 8-week and 12-week follow-up visits and a multivariable logistic regression analysis was conducted to obtain factors related to successful quitting at 12-week follow-up.

RESULTS

A total of 138 patients were included in this study (69 patients for each group). At 12-week follow-up, 31.9% of patients of telephone care (n = 22) succeeded in quitting smoking, while only 20.3% (n = 14) remained abstinent in the face-to-face care group. Telephone care compared with standard care increased the odds of success in stopping smoking (AOR = 3.279; 95% Cl: 1.191-9.026). Also, smokers with a previous quit attempt were significantly related to stopping smoking successfully (AOR = 4.724; 95% Cl: 1.131-19.727). Higher consumption of self-reported cigarette smoking was statistically associated with lower success rates in smoking cessation (AOR = 0.919; 95% Cl: 0.874-0.966).

CONCLUSION

Our data suggests that providing telephone care seems more effective in smoking cessation treatment compared with routine face-to-face intervention. However, further formal assessment as randomized clinical trial needs to be conducted for more evaluation.

Feasibility Randomized Controlled Trial of Face-to-Face Counseling and Mobile Phone Messages Compared to Usual Care for Smokeless Tobacco Cessation in Indian Primary Care: Project CERTAIN

INTRODUCTION

Smokeless tobacco (SLT) use in low- and middle-income countries has adverse health consequences. We hypothesize that it is feasible to test an intervention of mobile phone messages and face-to-face counseling sessions for SLT cessation in India.

AIMS AND METHODS

We conducted an exploratory, individual parallel two group, randomized controlled trial (RCT), with baseline and end-point (3 months from randomization) assessments in urban primary health centers in Odisha, India. A total of 250 current (i.e., users in the last 3 months) SLT users or dual users (ie, smokers and SLT users) were recruited to the trial (125 in each group). Participants were randomized to either routine care, face-to-face counseling, and reminder mobile messages or routine care only. The primary outcomes were to assess the feasibility of running a full RCT including recruitment, compliance, and retention.

RESULTS

A total of seven (77.8%) out of nine primary care centers took part in the trial. Out of the 315 SLT users invited to participate, 250 provided consent and were randomized [79.4% (95% CI: 74.5, 83.7)]. Out of the 250 randomized SLT users, 238 [95% (95% CI: 91.8, 97.5)] were followed up at 3 months (117 in the intervention group and 121 in the control group). Of the participants in the intervention group, 74 (63.8%) reported that they received the mobile messages.

CONCLUSIONS

This exploratory trial demonstrated the feasibility of delivering and evaluating an intervention of mobile phone messages and face-to-face counseling for SLT users in Indian primary care in a full randomized trial.

IMPLICATIONS

This study found that combining mobile messages with face-to-face counseling for smokeless tobacco users visiting primary health care settings in India is feasible in terms of recruitment of users, compliance with the intervention, and retention of study participants within the trial. The biochemically verified smokeless tobacco abstinence rate was higher in the intervention group compared with the control group. There was poor agreement between self-reported tobacco cessation and the measured salivary cotinine in smokeless tobacco users. The findings support the feasibility and acceptability of the intervention signaling the need for a larger clinical trial to test the effectiveness of the intervention.

Validation of Mobile Messages for an mHealth Intervention for Smokeless Tobacco Cessation in India

BACKGROUND

With the growth in use of mobile messages for behaviour change, the need to incorporate personal needs and cultural characteristics of target users has been promoted. The study aimed to describe the findings of content validation of mobile messages designed to promote smokeless tobacco cessation in primary care.

METHODS

This study used a concurrent mixed-method approach with 13 patients who were tobacco users at urban primary care clinics. The clarity and appeal of 32 messages were rated on a Likert scale from 1 to 10. A mean clarity and appeal score per message was generated. A 5-item discussion guide was used for in-depth interviews and data was analysed using framework analysis.

RESULTS

Participants found the content of the messages useful, and preferred shorter and audio formatted messages. The clarity scores for the messages ranged from 7.9 to 9.4 with an average score of 8.7 (SD 0.5). The appeal scores ranged from 7.3 to 9.2, with an average score of 8.5 (SD 0.6).

CONCLUSIONS

Twenty-six from a total of 32 messages were found appropriate and finalised for use. This methodology can be used when developing contextually relevant mobile message interventions in other low resource settings.

Designing a mobile health smokeless tobacco cessation intervention in Odisha, India: User and provider perspectives

Objective

There is limited evidence on the development of mobile health (mHealth) interventions for smokeless tobacco (SLT) cessation, despite its widespread use in South Asia. This formative qualitative study explored the perceptions of tobacco users and healthcare providers (HCPs) regarding developing a mHealth intervention for SLT cessation.

Methods

This was a qualitative study using in-depth interviews (IDIs) with tobacco users (n = 26) and primary care physicians (PCPs) (n = 5) and focus group discussions (FGDs) with counsellors (n = 2) in four urban primary health centres (UPHCs) in Berhampur, Odisha from February to March 2020. The data were coded and analysed by two researchers using a framework analysis method. The discussion guides and initial codes were developed based on the Transtheoretical Model (TTM) of behaviour change.

Results

The results were elaborated under four themes: (1) Current scenario of SLT use; (2) Barriers and facilitators for quitting SLT; (3) Barriers and facilitators for mHealth counselling; and (4) Design and delivery of the proposed intervention. SLT use was prevalent in the community regardless of sociodemographic factors. Peer factors accounted for both tobacco consumption as well as considering cessation. Participants considered mobile message counselling helpful and acceptable. Not having a mobile phone and illiteracy were identified as barriers while ease of access and rising popularity of social media applications were considered facilitators to the use of mHealth for quitting tobacco. Participants preferred messages that were pictorial, short and simple, in the local language, and tailored to individual's needs.

Conclusions

This is the first study that provides evidence within the Indian context that the text messaging platform may be used for delivering an SLT cessation intervention. The integration of a theoretical basis and research findings from target users can guide future intervention development.