WCTOH

Global Health

Background:
Tobacco cessation services are not widely available in low middle-income countries (LMICs) where smoking rates remain high. In Vietnam 45% of males are current smokers. We recently completed a two-arm randomized control trial comparing the effectiveness of two strategies for implementing tobacco use treatment (TUT) guidelines in community health centers (CHCs) in Vietnam. All sites received training and patient education materials. Intervention sites received a system for referring smokers to a village health worker (VHW) for multisession counseling. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted a post-intervention qualitative analysis of factors that facilitate or challenge implementation and sustainability of screening and treatment of TU in CHCs in Vietnam.

Methods:
Semi-structured interviews (N=42) were conducted with healthcare staff and VHWs in 18 CHCs. Interviews were transcribed verbatim and translated. Two investigators analyzed transcripts using an inductive and deductive approach to develop codes and identify themes relevant to the study research questions.

Results:
Interviews explored five domains of the CFIR (Intervention characteristics, Outer and Inner settings, Characteristics of individuals, and Process). Facilitators of program implementation included perceived importance of and need for smoking cessation services, ease of integrating the TUT intervention into routine care, and a high level of satisfaction with the quality of intervention components. Challenges to implementation included patient barriers (e.g., not ready to quit) and lack of a referral resource in comparison sites. The main challenge to sustainability is competing Ministry of Health (MOH) priorities that result in a relative lack of resources for TUT (e.g., training/materials) compared with other health programs.

Conclusions:
A robust planning process resulted in a good fit between current practice and the implementation strategies used to increase adoption of TUT guidelines in CHCs. Sustainability will depend on MOH commitment of resources, including ongoing training and integration with other programs.