Strengthening Cessation Capacity In The
National Tobacco Control Programme of India
Technical Presentation: Intervention and Evaluation Design
Rajmohan Panda / Manu Raj Mathur
Global Bridges Project
Public Health Foundation Of India
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
Methodology
MAP OF INDIA
Study Area: Odisha and Rajasthan
Intervention districts:
Sl. No.
Odisha
Intervention
districts
Rajasthan
Control
districts
Intervention
districts
Control
districts
1
Koraput
Bargard/Kalahadi Jaipur
Jodhpur
2
Balangir
Ganjam
Udaipur
3
Cuttack
Tonk
4
Khurda
Jhunjhunu
5
Kendrapada
Ajmer
Churu
Methodology
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: Different Health Facilities
Selection criteria of health facilities:
- Based on patient load
PHC: Primary Health Centre
CHC: Community Health Centre
SDH: Sub-divisional Hospital
Sampling
Multi-Stage Stratified Sampling
Stratified Random sampling
All CHCs ill be stratified
based on patient load and
divided into three categories
e.g. High,, Medium and Low.
Pros
Cons
1
Representative
sample of the
district
May not attain the
desired sampling size
of physicians (Nonparticipation)
2
Data may be
generalized to
the district
3
Cost effective
4
Less time
consuming
Methodology
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
6 months follow-up of doctors' knowledge and practices
Follow-up Survey- Midline
Training plan for Master trainers and participants
Primary care providers
Master Trainers
P
r
e
t
e
s
t
Online training
(10 hour
module)
1 month
Face-to-face
training
(1 day) of
selected
physicians
P
o
s
t
t
e
s
t
CERTIFICATE
15 days
P
r
e
t
e
s
t
Online training
(10 hour
module)
Face-to-face
training
(1 day) of
selected
physicians
3 months
P
o
s
t
t
e
s
t
CERTIFICATE
1 month
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 unit to counsel and track patients
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.
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
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.
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