| Summary: | Introduction
Tobacco smoking among tuberculosis (TB) patients leads to poorer
treatment outcomes. Smoking cessation support should be integrated into routine
TB care. We measured healthcare providers’ fidelity to a smoking cessation
intervention integrated into routine TB care, in Bangladesh and Pakistan. We
aimed to understand the role of providers and settings in the implementation of
behavior support (BS) messages for TB and smoking cessation.
Methods
The integrated BS intervention was implemented in TB clinics (24 public
and 1 private). Cross-sectional data were collected on the fidelity of delivery
of the BS intervention using a predefined fidelity index based on an existing
validated method of measuring intervention fidelity. Audio-recordings of patientprovider
BS sessions were coded using the fidelity index. Intervention fidelity was
presented as the proportion of sessions that implemented BS messages.
Results
A total of 96 sessions were conducted, 37 in Bangladesh and 59 in Pakistan.
In public settings, TB medication advice was offered in 91.9% (95% CI: 78.7–
97.2) of sessions in Bangladesh, and in 75.5% (95% CI: 62.4–85.1) of sessions
in Pakistan; whilst it was offered in 83.3% (95% CI: 43.7–97.0) of sessions in the
private setting in Pakistan. Patients’ smoking status was assessed in 70.3% (95%
CI: 54.2–82.5) of sessions in Bangladesh, and in 34.0% (95% CI: 22.7–47.4) of
sessions in the public setting and in 66.7% (95% CI: 30.0–90.3) of sessions in
the private setting in Pakistan. A quit date was set in 32.4% (95% CI: 19.6–48.5)
of all sessions in Bangladesh, and in 33.3% (95% CI: 9.6–70.0) of all sessions in
the public setting in Pakistan.
Conclusions
Fidelity to the intended delivery of the intervention was found to be
high for TB-related messages but not for smoking cessation messages. Clinic
contexts may play a mediating role in health workers’ opportunities to deliver
the intervention as planned.
TRIAL REGISTRATION
International Standard Randomized Clinical Trial Number
(ISRCTN43811467). Registered 23 March 2016, https://doi.org/10.1186/
ISRCTN43811467
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