INFOGRAPHIC (text only version)
Can behaviour change support reduce tobacco use in Nepal?
Nepal has the highest rates of tobacco use in South Asia. This makes tobacco use a major public health concern. For people with TB or lung problems, the risks are even greater. Our study involved working with healthcare workers and smokers to develop and test a behaviour change package that not only helped smokers to successfully quit, but was acceptable and feasible for healthcare workers to use and could be integrated into routine primary healthcare services in Nepal.
- Overall we found that behaviour change interventions delivered in primary care settings can be effective: 37%* of smokers in our study were able to quit following the intervention.
- However, there are important lessons to learn and share around tailoring materials to the local context and training and supporting healthcare workers to deliver the intervention.
* Verified at 3 months after the intervention.
5 lessons to share from our research
- Integrating tobacco cessation into routine TB care can have important benefits. Anxiety about their health and frequent contact with healthcare providers can result in higher quit success rates among TB patients than general smokers. Integrating cessation support into existing services can also be more cost effective in low-income countries.
- Behaviour support materials should be tailored to the local context. Stigma attached to women smokers in Nepal means they often hide their smoking. We revised our materials accordingly to show pictures of women tobacco users reinforcing the idea that the behaviour support package was for men AND women.
- Adequate training and ongoing support for the healthcare workers delivering behaviour support are essential. Basic behaviour change skills, eg reflective listening and tailoring advice accordingly take time to acquire. We found a move away from didactic classroom-style training towards interactive role play to be helpful.
- Widespread respect for doctors in Nepal means that brief initial smoking cessation advice from them can improve the patient’s willingness to engage in the longer-term behaviour support programme.
- A supportive political environment and a clear government mandate are key factors for the smooth implementation of smoking cessation interventions, eg the inclusion of smoking cessation indicators in the main outpatient register.
Click here for our full study: Understanding implementation and feasibility of tobacco cessation in routine primary care in Nepal: a mixed methods study
Click here for a PDF version of this infographic.