Behaviour change intervention for smokeless tobacco cessation in South Asians (BISCA): Its development, feasibility and fidelity testing in Pakistan and in the UK
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Click here to download the presentation (Powerpoint or viewer needed) | Author(s)
Kamran Siddiqi (presenting author), Omara Dogar (co-presenter), Rukhsana Rashid, Cath Jackson, Ian Kellar, Nancy O’Neill, Maryam Hassan, Furqan Ahmed, Mohammad Irfan, Heather Thomson, Javaid Khan , Zaheera Chatra, Shamsia Begum, Shajue Begum, Mohammed Idrees, Dot Read, Abul Khurshed, Manjit Kaur, Fauzia Jabeen, Dipul Ghosh and S. Wadud.
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Heather Thomson Health Improvement Manager, The Office of the Director of Public Health, Leeds |
Dr Kamran Siddiqi Clinical Senior Lecturer in Epidemiology and Public Health, University of York | Abstract Background:
People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK.
Methods:
We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering BCI, respectively. Quit success was assessed at six months by saliva/urine cotinine.
Results:
The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at six months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – max score achievable 44; and between 1.4 and 14 for the quality of interaction - max score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation.
Conclusion:
We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.
| Source of funding: N/A
| Declaration of interest: None
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