Funding agency: Medical Research Council, UK
Duration: 24 months (November 2018 to October 2020)
Principal Investigator: Dr Abhijit Nadkarni
Co-Investigators: Prof Richard Velleman, Dr. Pratima Murthy,and Dr. Felix Naughton.
Background: India is the second largest consumer and third largest producer of tobacco in the world; and has one of the highest mortality rates related to tobacco. Although there is good evidence for the effectiveness of tobacco cessation interventions, they are not completely suitable for the Indian context because they focus on smoked tobacco (whereas the most commonly used tobacco in India is smokeless tobacco) and are designed to be delivered by healthcare workers (a limited resource in India). Hence, despite the growing public health impact of tobacco use, only a very small proportion of those who want to discontinue tobacco use receive any help to quit. One way of increasing access to tobacco cessation interventions in low resource settings is to develop and scale up an effective and contextually appropriate but non resource-intensive intervention. ToQuit aims to develop and then preliminarily evaluate, a contextually appropriate intervention, that can be delivered using mobile text messaging (a cheap and easily available technological platform in India) to large numbers of tobacco users, quickly and at low cost.
1) Develop a tobacco cessation intervention package, to be delivered in India using mobile phone technology;
2) Examine acceptability and feasibility in an Indian setting;
3) Evaluate impact on tobacco quit rates; and
4) Fine-tune procedures for the definitive testing of the effectiveness of the intervention within a feasibility Randomised Controlled Trial.
Study setting: Participants will be identified through screening in primary and tertiary care settings and workplaces, and referrals by primary care physicians/ healthcare professionals in Goa, India.
Design: We will follow a sequential process with a feedback loop that allows refinement of the intervention based on data collection. The research study will unfold over three phases. The formative research phase will aim to review existing literature and research to inform the intervention development process and identify the theoretical underpinning. This will be followed by a case series for testing the proposed intervention and monitoring quit rates and finally a randomized controlled trial to examine the acceptability, feasibility and preliminary impact of the developed intervention.
The primary scientific value of ToQuit is that it takes a systematic approach to building the foundation that will lead up to future research efforts (definitive randomized controlled trial) crucial for establishing quality evidence for interventions.
ToQuit will help tobacco users to reduce levels of harm caused to them, by transforming a way of helping which has in the past been delivered face-to-face, only by highly trained and expensive healthcare workers. The treatment support will be provided in a much more accessible and widely available form, by using mobile phones (widely owned across India and other low-and-middle-income countries [LMICs]). If successfully developed and found to be cost-effective, our intervention can reach millions of people across LMICs and could be a real game-changer in the field of public health.
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