Potential for sustainability of strategies for implementing tobacco use treatment guidelines in the Vietnam public healthcare system: qualitative post intervention assessment
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1 |
New York University, Rory Meyers College of Nursing, United States of America |
2 |
Emory University, Behavioral Sciences and Health Education, United States of America |
3 |
Institute of Social and Medical Studies, Viet Nam |
4 |
New York University School of Medicine, Population Health, United States of America |
Publication date: 2018-03-01
Tob. Induc. Dis. 2018;16(Suppl 1):A337
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ABSTRACT
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.