Table 1.
TB & Tobacco intervention components and messages
| Materials | Content | Messages and BCT taxonomy code [24] |
|---|---|---|
| Flipbook: for use during consultations with all TB patients following diagnosis and at any point during the 6 months of TB treatment to reinforce messages and support quit attempts | Eight pages with photo pages facing patients and text facing health professionals. One version with photos targeting male patients and one version with photos targeting female patients: the first 5 pages include key messages on TB management, and the final 3 pages have messages regarding tobacco (cigarettes and smokeless) |
TB messages: (i) It is very likely that your TB will be cured if you take your medicines as instructed (ii) Keep taking medicines regularly (iii) Come for scheduled appointments, your health worker is here to support you (iv) Understanding how TB spreads (v) Importance of social support (vi) Adopt a healthy diet and lifestyle, including quitting tobacco Cessation messages: (i) Abrupt cessation: set a quit date and then, “not a puff” (ii) How to deal with side effects (iii) Identifying triggers and alternative strategies (iv) Consequences of tobacco use (cigarettes and smokeless) on TB, long-term health and finances (v) Dangers of second-hand smoke Behaviour change techniques: (i) Goal-setting (1.1) (ii) Reducing negative emotions (1.2) (iii) Action-planning (1.4) (iv) Prompting social support (3.1, 3.2, 3.3) (v) Instructions on performing behaviours (4.1) (vi) Information on health and emotional consequences (5.1, 5.6) (vii) Habit formation (8.3) (viii) Comparative imagining of future outcomes (9.3) (ix) Reducing negative emotions (11.2) (x) Reducing exposure to cues for behaviour (12.3) (xi) Building rapport, being an active listener |
| Leaflet: for TB patients, their carers and family members | Using photos and illustrations and simple text highlighting the consequences of tobacco use (cigarettes and smokeless), link with TB, benefits of quitting and how to deal with side effects of quitting | |
| Two posters: for use within TB clinic waiting areas | One presenting health benefits of quitting (general, not TB-specific) and one advertising the cessation service | |
| A health worker guide: to be used in conjunction with the flipbook, leaflet and posters | Providing the evidence behind the key messages, tips for adaptation and strategies for building rapport and good communication with both male and female patients | |
| Further adaptations made based on TB & Tobacco trial process evaluation | ||
| Desk reminder: one page, laminated to be stuck on or beside the TB health worker’s desk | Reiterating key messages and including details of the TB & Tobacco website where all materials are available for further reference | |
| Training of trainers (ToT): Half-day programme |
Introducing the intervention, key messages and underlying evidence. How to deliver the messages and support TB health workers to deliver Includes a country-specific 10-minute video modelling how to ask about tobacco use, advise and support patients to quit |
|
| Training session: 2-hour training session for TB health workers delivered by trainers following the ToT above | Introducing the intervention and key cessation messages, and how to complete the tobacco columns in the recording forms. Including the 10-minute video above | By delivering these key messages using simple BCTs, TB health workers help their patients to quit as part of routine care |
| Awareness-raising video: for TB programme managers and policy-makers | Three-minute video explaining the link between TB and tobacco and the need to include tobacco cessation support for TB patients | Inclusion of tobacco cessation within the TB programme is feasible and can improve TB outcomes |
All training and intervention materials are freely available in Urdu, Bengali, Nepalese and English from the TB & Tobacco website: https://tbandtobacco.org/