Strengthening Cessation Capacity in Indian Tobacco Program

1. Strengthening Cessation Capacity In The National Tobacco Control Programme of IndiaTechnical Presentation: Intervention and Evaluation Design Rajmohan Panda / Manu Raj Mathur Global Bridges Project Public Health Foundation Of India

2. Goal and Objective Goal To strengthen the tobacco cessation component of India’s ‘National Tobacco Control Programme’ (NTCP) by building capacity in physicians working in primary and secondary health care for providing evidence-based tobacco cessation interventions. Objectives To design and evaluate a training program to assist physicians in primary and secondary health care to deliver an evidence-based brief tobacco cessation intervention in health care settings in selected districts of Odisha and Rajasthan Create a resource network and training model for cessation that can be advocated for scaling at the pan-India level To build the capacity of NTCP state officials to advocate for the provision of evidence-based tobacco cessation interventions at state and district level

3. Methodology MAP OF INDIA Study Area: Odisha and Rajasthan Intervention districts:

4. Methodology PHC: Primary Health Centre CHC: Community Health Centre SDH: Sub-divisional Hospital Design of the study: Quasi-experimental Study participants: Primary health care providers in the primary and secondary health facilities of Odisha and Rajasthan Sample size of physicians: Phase-I • around 50 master trainers Phase-II • 400 physicians Sampling unit: DifferentHealth Facilities Selection criteria of health facilities: - Based on patient load

5. Sampling Stratified Random sampling All CHCs ill be stratified based on patient load and divided into three categories e.g. High,, Medium and Low. Multi-Stage Stratified Sampling

6. Methodology Follow-up Survey- Midline 6 months follow-up of doctors' knowledge and practices 6 months follow-up of doctors‘:- {knowledge and practices) 6 months follow-up of doctors' knowledge and practices After one year of Intervention End line

7. Training plan for Master trainers and participants Primary care providers Post - test Pre- test Pre- test Post - test 1 month 15 days 3 months 1 month Master Trainers

8. Patient follow-up system Patient Follow up In-Charge (PFI) to be identified from facility of the physicians who are trained on tobacco cessation. The PFI will be rolled under an incentive based follow-up system for the smokers visiting the facility and receiving cessation advice. The identified PFI will be provided with a register with a standard format in order to be able to track the smokers. They will maintain the tobacco use database for the patients receiving cessation advice at their respective facility. Core Working Model The tobacco cessation project will work as a network between the master mentor, physicians, patient follow up in-charge as well as the patients. A physician, a contact person/counsellor will form one unitto counsel and track patients

9. Expected Outcomes Outcome measures Baseline measures: Short questionnaire for baseline screening including inclusion criteria, demographics, tobacco-use history, determination to quit and self-efficacy. Primary outcome measures The primary end point will be continuous abstinence rate over the last four weeks of study intervention defined as proportion of participants who report abstaining from tobacco during the indicated period. Secondary outcome measures a) Abstinence rates at 3 and 6 months. All participants lost to follow-up will be considered tobacco user. b) Self-reported changes in daily tobacco consumption, quit attempts, and intention to quit. c) Cost of tobacco cessation and related health care resources to the health service and to the patient over 6 months. There will be lag of about 15-20 days after follow up period of 1, 3 and 6 months since the abstinence rates will be calculated after completion of the desired time frames.

10. Expected Impact The impact of the training program will be evaluated by conducting exit interviews? and follow-up of the patients who are advised by the physicians on tobacco cessation. Sensitization of the physicians will be followed up for a span of 06 months. Six months total: Self-reported point prevalence smoking/ tobacco cessation rates at one month; Self-reported continuous abstinence from zero to three months and from zero to six months; Follow-up period: 1, 3, 6 months; Point prevalence of abstinence at 6 months Process measures: Patients not having a visit during the 6 or 12 month periods were assumed to be smokers Validation: Biochemical tests? In a small sample of patients

11. The objective of this media strategy is to: Communicate to the media at the importance NTCP and further the collaborative initiative to provide tobacco cessation services nationally. This can be drummed up in the form of: • Launches in both states, and at national level which provides insights on need, for prevention, and care in rural and urban settings • Enhance Quality of Health professionals • Enhance quality of healthcare and reach impeccably – provides the bridge between the patient and doctors in a much more efficient manner.

12. Activities Planned Developing a curtain-raiser note for State and National media, enabling them to think and report about the project Contribute Articles/Op-Eds. At least one article by a JS level officer or above from the Ministry and one by a Project expert Develop regular notes for Feature stories on the project highlighting key success stories and related matter Target popular media especially niche magazines like, Indian Express (Health), Hindu, ToI, HT, Mint, Mail Today, DNA To organize speaking engagements in English and Hindi channels Online Media like issuing a National web release, One World South Asia, Zee News.Com, India.org, MintOnline, can push the message to a large number of netizens Media kit for journalists – This can contain an overview of the recent situation, what’s new data, media FAQs, etc. Link Social Media: With PHFI social media accounts and also PHFI website which has a lot of visitors and followers