Using behaviour change interventions to decrease tobacco use in Nepal

The problem
Tobacco use is a growing challenge and a public health concern in Nepal, especially in urban areas and amongst the young population. Tobacco use increases the risk of communicable and non-communicable diseases, and contributes to morbidity and mortality. It is a learned behaviour that results in a physical addiction to nicotine for the majority of smokers. Stopping smoking can be difficult for many individuals and many studies show that counselling and medicine helps people quit smoking (1). Increasing motivation has been identified as an important part of treating tobacco addiction as it increases smokers’ willingness to quit (2).
What we did
HERD, in collaboration with the National Tuberculosis Centre (NTC), conducted a study to assess the feasibility of using a behaviour change intervention within the Practical  Approach to Lung Health (PAL) programme in 2 districts of Nepal: Kathmandu and Rupandehi. Within these districts, all the patients in the selected primary health care centres with respiratory problems (including TB) who smoked were given behaviour change counselling to help them quit smoking and to improve their health.
What does the counselling involve?
The intervention included a counselling session run by outpatient department (OPD) staff to patients who smoke. Staff employed behaviour change techniques, addressing factors such as maintaining willpower and motivation to give up smoking. They also used information, education and communication (IEC) materials such as flipbooks and leaflets (pictured above) to help convey important lifestyle messages.
Findings from the study

  • It is feasible to implement a smoking cessation intervention in primary health care centres, particularly if the intervention is targeted at those patients who are motivated to quit.
  • 37% of smokers who received the intervention were able to quit smoking following the intervention.
  • Use of various IEC materials makes the behaviour support intervention more effective. For staff, the flipbook makes the counselling session with patients more structured and effective; the leaflet, as well as providing information, also serves as a good reminder for patients.
  • Integrating smoking cessation within routine primary health care helps deliver the intervention effectively. It also increases the likelihood of helping people to stop smoking.

For more information about the research, please email Sudeepa Khanal, HERD at: For more detailed findings and policy considerations see the related policy brief.

  1. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. (2004) Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews. (3).
  2. Roberts NJ, Kerr SM and Smith SMS. (2013) Behavioral interventions associated with smoking cessation in the treatment of tobacco use. Health Services Insights. 6: 79-85.
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