Trial reportBMC health services research2019
Using behaviour change theory to train health workers on tobacco cessation support for tuberculosis patients: a mixed-methods study in Bangladesh, Nepal and Pakistan.
Trial report in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Facilitators and barriers to smoking cessation support among professionals in social and community service settings: a systematic review and thematic synthesis.Health education research · 2025Pooled it
- Trial
- Cost-effectiveness of a mTB-Tobacco intervention for smoking cessation in people with tuberculosis: an economic evaluation of a cluster randomised controlled trial.The Lancet regional health. Southeast Asia · 2026Article
- Article
- Readiness assessment as a strategy, not an afterthought: leveraging implementation science to integrate tuberculosis comorbidity care in Pakistan's health system.Frontiers in tuberculosis · 2026Article
- Article
- Training of Community Health Workers in Diabetes Lead to Improved Outcomes for Diabetes Screening and Management in Low- and Middle-Income Countries: Protocol for a Systematic Review.JMIR research protocols · 2024Article
- Educational technology on tuberculosis: construction shared with Primary Health Care nurses.Revista brasileira de enfermagem · 2023Article
- Feasibility of tobacco cessation intervention at non-communicable diseases clinics: A qualitative study from a North Indian State.PloS one · 2023Article
- Article
- Scaling up tobacco cessation within TB programmes: findings from a multi-country, mixed-methods implementation study.Health research policy and systems · 2022Article
- Health workers' perceptions on where and how to integrate tobacco use cessation services into tuberculosis treatment; a qualitative exploratory study in Uganda.BMC public health · 2021Article
- Article
- Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: Contextual differences and opportunities.Tobacco induced diseases · 2021Article
- The syndemic challenge of tuberculosis and tobacco use.Tobacco induced diseases · 2021Article
- Evaluation of competence training for the minimally trained health worker in type 2 diabetes: A cluster randomized controlled trial.Medicine · 2020Article
- The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study.BMC health services research · 2020Article
- A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries.Tobacco induced diseases · 2020Review
- Health worker and patient views on implementation of smoking cessation in routine tuberculosis care.NPJ primary care respiratory medicine · 2019Article
- Smoked Tobacco, Air Pollution, and Tuberculosis in Lao PDR: Findings from a National Sample.International journal of environmental research and public health · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundLow- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by health workers effectively promotes tobacco cessation. There is, however, a paucity of training to support LMIC health workers deliver effective tobacco cessation behavioural support. The TB and Tobacco Consortium undertook research in South Asia to understand factors affecting TB health workers' delivery of tobacco cessation behavioural support, and subsequently developed a training package for LMICs.
methodsUsing the "capability, opportunity, and motivation as determinants of behaviour" (COM-B) framework to understand any issues facing health worker delivery of behaviour support, we analysed 25 semi-structured interviews and one focus group discussion with TB health workers, facility in-charges, and national tuberculosis control programme (NTP) staff members in each country. Results were integrated with findings of an adapted COM-B questionnaire on health worker confidence in tobacco cessation support delivery, administered to 36 TB health workers. Based on findings, we designed a guide and training programme on tobacco cessation support for health workers.
resultsQualitative results highlighted gaps in the majority of health workers' knowledge on tobacco cessation and TB and tobacco interaction, inadequate training on patient communication, insufficient resources and staff support, and NTPs' non-prioritization of tobacco cessation in all three countries. Questionnaire results reiterated the knowledge deficits and low confidence in patient communication. Participants suggested strengthening knowledge, skills, and competence through training and professional incentives. Based on findings, we developed an interactive two-day training and TB health worker guide adaptable for LMICs, focusing on evidence of best practice on TB and tobacco cessation support, communication, and rapport building with patients.
conclusionsTB health workers are essential in addressing the dual burden of TB and tobacco faced by many LMICs. Factors affecting their delivery of tobacco cessation support can be identified using the COM-B framework, and include issues such as individuals' knowledge and skills, as well as structural barriers like professional support through monitoring and supervision. While structural changes are needed to tackle the latter, we have developed an adaptable and engaging health worker training package to address the former that can be delivered in routine TB care.
trial registrationISRCTN43811467 .
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.