PDF(Pubmed)
Abstract：
BACKGROUND: Article 14 of the WHO \'Framework Convention on Tobacco Control\' recommends, that all oral healthcare providers provide support for tobacco cessation, to all patients. Despite evidence on the effectiveness of tobacco cessation interventions in dental settings, implementation remains low in most high-burden countries like Pakistan. A pragmatic pilot trial of a dentist-delivered behavioural support intervention for smokeless tobacco (ST) cessation, was conducted in dental hospitals in Pakistan. This paper presents the findings of the process evaluation of the trial.
METHODS: A mixed-method process evaluation of a multi-centre randomised control pilot trial of dentist-delivered behavioural support intervention ST cessation was conducted. The intervention included three sessions namely: pre-quit, quit and post-quit sessions. The process evaluation involved: semi-structured interviews with trial participants (n = 26, of which dental patients were n = 13 and participating dentists were n = 13 conducted from June-August 2022); and fidelity assessment of audio recordings of the intervention sessions (n = 29). The framework approach was used to thematically analyse the interview data.
RESULTS: Overall the trial procedures were well accepted, however, young patients expressed uneasiness over revealing their ST use status. The intervention was received positively by dentists and patients. Dentists identified some challenges in delivering behavioural support to their patients. Of these, some were related to the contents of the intervention whereas, others were related to the logistics of delivering the intervention in a clinical setting (such as workload and space). Acceptability of the intervention resources was overall low amongst young patients as they did not take the intervention resources home due to fear of their family members finding out about their ST use. The intervention was successful in achieving the intended impact (in those who engaged with the intervention), i.e., change in the patients\' ST use behaviour. Giving up ST with the aid of behavioural support also had an unintended negative effect i.e., the use of harmful substances (cannabis, cigarettes) to give up ST use. Patients\' satisfaction with their dental treatment seemed to influence the intervention outcome.
CONCLUSIONS: While there are many variables to consider, but for the participants of this study, behavioural support for abstinence delivered through dentists during routine dental care, appears to be an acceptable and practical approach in helping patients give up ST use, in a country like Pakistan, where negligible support is offered to ST users.
METHODS: A mixed-method process evaluation of a multi-centre randomised control pilot trial of dentist-delivered behavioural support intervention ST cessation was conducted. The intervention included three sessions namely: pre-quit, quit and post-quit sessions. The process evaluation involved: semi-structured interviews with trial participants (n = 26, of which dental patients were n = 13 and participating dentists were n = 13 conducted from June-August 2022); and fidelity assessment of audio recordings of the intervention sessions (n = 29). The framework approach was used to thematically analyse the interview data.
RESULTS: Overall the trial procedures were well accepted, however, young patients expressed uneasiness over revealing their ST use status. The intervention was received positively by dentists and patients. Dentists identified some challenges in delivering behavioural support to their patients. Of these, some were related to the contents of the intervention whereas, others were related to the logistics of delivering the intervention in a clinical setting (such as workload and space). Acceptability of the intervention resources was overall low amongst young patients as they did not take the intervention resources home due to fear of their family members finding out about their ST use. The intervention was successful in achieving the intended impact (in those who engaged with the intervention), i.e., change in the patients\' ST use behaviour. Giving up ST with the aid of behavioural support also had an unintended negative effect i.e., the use of harmful substances (cannabis, cigarettes) to give up ST use. Patients\' satisfaction with their dental treatment seemed to influence the intervention outcome.
CONCLUSIONS: While there are many variables to consider, but for the participants of this study, behavioural support for abstinence delivered through dentists during routine dental care, appears to be an acceptable and practical approach in helping patients give up ST use, in a country like Pakistan, where negligible support is offered to ST users.
摘要：
背景：世界卫生组织《烟草控制框架公约》第14条建议，所有口腔保健提供者都为戒烟提供支持，对所有患者。尽管有证据表明戒烟干预在牙科环境中的有效性，在巴基斯坦等大多数高负担国家，执行情况仍然很低。针对无烟烟草（ST）戒烟的牙医提供的行为支持干预的务实试点试验，是在巴基斯坦的牙科医院进行的。本文介绍了试验过程评估的结果。
方法：对牙医提供行为支持干预ST停止的多中心随机对照试验进行了混合方法过程评估。干预包括三次会议，即:戒烟前，退出和退出后的会议。过程评估涉及：与试验参与者的半结构化访谈（n=26，其中牙科患者为n=13，参与牙医为n=13，从2022年6月至8月进行）;和干预会议录音的保真度评估（n=29）。框架方法用于主题分析访谈数据。
结果：总的来说，试验程序被广泛接受，然而,年轻患者对揭示其ST使用状态表示不安。牙医和患者积极接受干预。牙医发现了在向患者提供行为支持方面的一些挑战。其中,有些与干预的内容有关，而，其他与在临床环境中实施干预的后勤相关(如工作量和空间).在年轻患者中，干预资源的可接受性总体较低，因为他们担心家人会发现他们的ST使用情况，因此他们没有将干预资源带回家。干预措施成功实现了预期的影响(在参与干预措施的人中)，即，患者ST使用行为的变化。在行为支持的帮助下放弃ST也有意想不到的负面影响，即使用有害物质(大麻，香烟)放弃ST使用。患者对牙科治疗的满意度似乎会影响干预结果。
结论：虽然有许多变量需要考虑，但是对于这项研究的参与者来说，在常规牙科护理期间通过牙医提供的禁欲行为支持，在帮助患者放弃使用ST时似乎是一种可接受且实用的方法，在像巴基斯坦这样的国家，为ST用户提供的支持微不足道。
方法：对牙医提供行为支持干预ST停止的多中心随机对照试验进行了混合方法过程评估。干预包括三次会议，即:戒烟前，退出和退出后的会议。过程评估涉及：与试验参与者的半结构化访谈（n=26，其中牙科患者为n=13，参与牙医为n=13，从2022年6月至8月进行）;和干预会议录音的保真度评估（n=29）。框架方法用于主题分析访谈数据。
结果：总的来说，试验程序被广泛接受，然而,年轻患者对揭示其ST使用状态表示不安。牙医和患者积极接受干预。牙医发现了在向患者提供行为支持方面的一些挑战。其中,有些与干预的内容有关，而，其他与在临床环境中实施干预的后勤相关(如工作量和空间).在年轻患者中，干预资源的可接受性总体较低，因为他们担心家人会发现他们的ST使用情况，因此他们没有将干预资源带回家。干预措施成功实现了预期的影响(在参与干预措施的人中)，即，患者ST使用行为的变化。在行为支持的帮助下放弃ST也有意想不到的负面影响，即使用有害物质(大麻，香烟)放弃ST使用。患者对牙科治疗的满意度似乎会影响干预结果。
结论：虽然有许多变量需要考虑，但是对于这项研究的参与者来说，在常规牙科护理期间通过牙医提供的禁欲行为支持，在帮助患者放弃使用ST时似乎是一种可接受且实用的方法，在像巴基斯坦这样的国家，为ST用户提供的支持微不足道。
