Smoking Cessation Clinical Trial
Official title:
Effectiveness of a Combined CHW and Text Messaging-based Tobacco Intervention in India Project MUKTI: A Multi-Unit Kit for Tobacco Intervention
The study is a multi-center 1-year community-based cluster randomized controlled trial to assess the role of a combined community health worker and mobile health intervention in controlling one of the most common cardiovascular risk factors, tobacco use. Participants will include 560 adults, 18-70 years of age, from the urban communities of Dalkhola, West Bengal, and Jabalpur, Madhya Pradesh, India. The hypothesis of the study is that this combined approach can result in increased quit rate among tobacco users.
Smoking tobacco is a major contributor to the global cardiovascular disease burden. India
bears a huge part of this burden and it is estimated that nearly a quarter million
individuals aged >15 years consume tobacco in India. Moreover, about 70% of tobacco deaths
are reported to be in the age range of 30-69 years.
Motivational interviewing (MI) is an innovative manner of communication which puts the focus
on the patient and strengthens their motivation for behavior change without overt
confrontation or persuasion. MI delivered by community health workers (CHW) is part of the
strategy planned by the investigators.
In order to deliver personalized assistance and increase penetration of the required
intervention into different parts of the country, text messaging is a promising strategy in
low and middle-income countries but there is no data regarding its application for tobacco
use in India.
The investigators plan to screen 560 individuals between the age of 18 and 70 years for
smoking from 16 randomly selected clusters in the economically backward urban towns of
Dalkhola (West Bengal) and Jabalpur (Madhya Pradesh). The screening will be done using house
to house visits by CHWs who will administer a questionnaire based on the WHO STEPS survey. An
individual identified as a chronic tobacco user irrespective of his/her stage of behavior
change will be eligible for further participation in the study and assigned to the
appropriate intervention arm. Clusters will be randomized to either receive the combined
intervention or usual care.
Apart from screening and recruitment, CHWs will be responsible for differentiating
individuals between being pre-contemplative vs contemplative. Based on their readiness to
quit, participants will receive a structured intervention which involves motivational
interviewing delivered by the CHW in their homes and weekly support provided through regular
mobile text messages.
The CHWs will be chosen from the study population based on a set of criteria through a formal
selection panel after consulting with the local leaders and physicians. They will undergo a
week of training for the screening process, an additional week for the intervention and
finally a refresher course every 6 months.
The text messages are selected from a pre-determined database of messages and the content of
which changes based on the individual's stage of behavior change. The messages are delivered
automatically every other day of the week and are controlled by the investigators in
Cleveland, Ohio, USA.
The control group, during their screening visit, will be informed of their problems, given a
brief pamphlet and encouraged to seek physician help.
The investigators hypothesize that a community health worker based intervention, utilizing
motivational interviewing and health education, coupled with text messaging based support
will lead to increased quit rates amongst participants who are daily smokers.
At the end of one year, the self-reported abstinence of the participants in the intervention
arm will be recorded and biochemically verified with a carbon monoxide breath analyzer test.
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