Behaviour change intervention for smokeless tobacco (ST) cessation delivered through dentists within a dental setting: a feasibility study protocol

Rasool, Shaista; Holliday, Richard; Khan, Zohaib; Dobbie, Fiona; Bauld, Linda

doi:10.1038/s41405-022-00104-w

Cited by 3 publications

(8 citation statements)

References 35 publications

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“… 44 Such individuals are less likely to quit because of these factors, which in turn can lead to greater dependence. 45 , 46 These influences combined with the cultural barriers specific to ST use, scarcity of referral centres, 27 and unavailability of free nicotine replacement therapy in Pakistan serve as potential barriers translating into the dentists’ inability to identify ST users and their reluctance to offer cessation advice to their patients. Another reason that explains the difference in the history-taking practices of dentists, is that many studies and all the evidence from Pakistan on this topic is quantitative in nature.…”

Section: Discussionmentioning

confidence: 99%

“…The detailed methods of the study are published in a protocol paper elsewhere. 27 Briefly, this was an exploratory qualitative study, involving 24 in-depth interviews with dentists ( n = 12) and dental patients ( n = 12).…”

Section: Methodsmentioning

confidence: 99%

“…Dentists working in five specialties of dentistry namely: Prosthodontics; periodontics; orthodontics; operative dentistry; and; maxillofacial surgery and dental patients (who were ST users) visiting the hospitals were eligible to participate in the study. 27 …”

Section: Methodsmentioning

confidence: 99%

“…Twelve patients (who were ST users) were purposively selected from the general, outpatient department (OPD). 27 Dental patients visiting the OPD were invited after their tobacco use history had been documented by the OPD consultant. The interview appointment was scheduled with them after seeking their informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…This study is part of a larger feasibility study, which aims to assess the feasibility of implementing a structured behavior support intervention for ST cessation within dental hospitals in Pakistan. 27 …”

Section: Introductionmentioning

confidence: 99%

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Smokeless Tobacco Cessation Support in Dental Hospitals in Pakistan: Dentists and Dental Patients’ Perspectives on Current Practices, Support Needed, and Opportunities Available

Rasool

Dobbie

Boeckmann

et al. 2023

Nicotine and Tobacco Research

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Introduction Despite evidence on the effectiveness of tobacco cessation interventions in dental settings, the implementation remains low, especially for smokeless tobacco (ST). The purpose of this study was to develop an understanding of the influences governing the implementation of ST cessation support in dental hospitals. Methods A multi-centre qualitative study was conducted at two tertiary-care dental hospitals, in Pakistan. Semi-structured interview guide, guided by the Capability-Opportunity-Motivation-Behaviour (COM-B) model, were used to capture the views of dentists (n=12) and dental patients (n=12), regarding ST cessation support in dental hospitals. Framework approach was used to thematically analyse the data. Results Screening of ST users in routine dental practice was seldom practiced and the cessation support offered was brief advice. Barriers identified by dentists included: fear of offending and stereotyping patients; lack of knowledge and skills; lack of privacy; lack of belief in the effectiveness of behavioural support; lack of time and workload pressure; ST use amongst dentists; lack of referral systems and; the absence of a mandatory requirement of offering ST cessation support. Facilitators included: delivering support through junior dentists and the length of interaction between the dentist and the patient. Naswar was the most common ST product used by dental patients. Patients reported receiving negligible cessation support from any healthcare provider. Conclusions A range of influences governing the implementation of ST cessation support in dental hospitals were identified. These findings can inform the implementation of behavioural interventions for ST cessation in dental and other clinical settings, in low and middle-income countries. IMPLICATIONS Smokeless Tobacco (ST) control considerably lags, in comparison to the control of combustible tobacco. This is the first study that qualitatively explores the implementation of ST cessation support in dental settings in Pakistan. Utilizing the ‘Capability-Opportunity-Motivation-Behaviour’ model, it provides an in-depth understanding of the inability of dentists in implementing effective behavioural interventions for ST cessation support in routine dental practice. Highlighting the striking discrepancy between the patients’ need for and receptivity towards cessation support and the dentists’ concerns over their patients’ receptivity towards cessation support, it calls for the need for effective implementation strategies to optimize dentist-led tobacco cessation interventions in low-resource settings.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Smokeless Tobacco Cessation Support in Dental Hospitals in Pakistan: Dentists and Dental Patients’ Perspectives on Current Practices, Support Needed, and Opportunities Available

Rasool

Dobbie

Boeckmann

et al. 2023

Nicotine and Tobacco Research

Self Cite

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Behavior Change Intervention for Smokeless Tobacco Cessation Delivered Through Dentists in Dental Settings: A Pragmatic Pilot Trial

Rasool,

Holliday,

Khan

et al. 2023

Nicotine and Tobacco Research

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Introduction Evidence on smokeless tobacco (ST) cessation interventions is scarce. The South Asian (SA) region which shares more than 90% of the burden of ST use, is grossly underrepresented in research on ST cessation. This study aimed to assess the feasibility of delivering and investigating a behavioural support intervention for ST cessation in dental settings in Pakistan. Methods A multi-centre, pilot, 2-armed parallel group, individually randomised control trial, with a 1:1 allocation ratio, was conducted at two dental hospitals. Eligibility criteria included: being a ST user; seeking dental treatment and; not currently accessing cessation support. All participants were provided written self-help, ST cessation material. The intervention group also received a dentist-delivered, bespoke behavioural support intervention for ST cessation developed for users of SA origin. Participants were followed up telephonically at three and six months. Self-reported six month abstinence was verified by salivary cotinine. Analysis was descriptive, with 95% confidence intervals presented where appropriate. Results 100 participants were successfully recruited from the selected hospitals. Of these 78% continued to engage throughout the study duration and provided primary outcome data, whereas, 63% completed all hospital visits. The outcome measures were successfully collected. Biochemically verified six-month abstinence in the intervention and control group was 10% and 4%. Conclusions It was feasible to deliver and evaluate a dentist-delivered behavioural support intervention for ST cessation in Pakistan. The data suggested that the intervention may improve ST quit rates. The findings of this study will be useful in informing the design of future definitive studies. IMPLICATIONS To our knowledge this is the first pragmatic pilot trial on ST cessation in dental settings in Pakistan and the first trial on dentist-delivered structured behavioural support intervention for ST cessation. It adds to the scarce, trial evidence base on ST cessation interventions. Findings suggest behavioural support intervention for ST cessation may improve quit rates. The trial was conducted in a country with poor ST control measures, where ST products are not taxed, the products are sold openly to and by minors and the users are offered negligible cessation support. The findings may therefore be generalisable to LMICs and particularly South Asian countries, with similar policy backgrounds.

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Process evaluation of a pragmatic feasibility trial on smokeless tobacco cessation intervention delivered in dental hospitals

Rasool,

Dobbie,

Khan

et al. 2024

BMC Public Health

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Background Article 14 of the WHO ‘Framework Convention on Tobacco Control’ recommends, that all oral healthcare providers provide support for tobacco cessation, to all patients. Despite evidence on the effectiveness of tobacco cessation interventions in dental settings, implementation remains low in most high-burden countries like Pakistan. A pragmatic pilot trial of a dentist-delivered behavioural support intervention for smokeless tobacco (ST) cessation, was conducted in dental hospitals in Pakistan. This paper presents the findings of the process evaluation of the trial. Methods A mixed-method process evaluation of a multi-centre randomised control pilot trial of dentist-delivered behavioural support intervention ST cessation was conducted. The intervention included three sessions namely: pre-quit, quit and post-quit sessions. The process evaluation involved: semi-structured interviews with trial participants (n = 26, of which dental patients were n = 13 and participating dentists were n = 13 conducted from June-August 2022); and fidelity assessment of audio recordings of the intervention sessions (n = 29). The framework approach was used to thematically analyse the interview data. Results Overall the trial procedures were well accepted, however, young patients expressed uneasiness over revealing their ST use status. The intervention was received positively by dentists and patients. Dentists identified some challenges in delivering behavioural support to their patients. Of these, some were related to the contents of the intervention whereas, others were related to the logistics of delivering the intervention in a clinical setting (such as workload and space). Acceptability of the intervention resources was overall low amongst young patients as they did not take the intervention resources home due to fear of their family members finding out about their ST use. The intervention was successful in achieving the intended impact (in those who engaged with the intervention), i.e., change in the patients’ ST use behaviour. Giving up ST with the aid of behavioural support also had an unintended negative effect i.e., the use of harmful substances (cannabis, cigarettes) to give up ST use. Patients’ satisfaction with their dental treatment seemed to influence the intervention outcome. Conclusion While there are many variables to consider, but for the participants of this study, behavioural support for abstinence delivered through dentists during routine dental care, appears to be an acceptable and practical approach in helping patients give up ST use, in a country like Pakistan, where negligible support is offered to ST users.

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Behaviour change intervention for smokeless tobacco (ST) cessation delivered through dentists within a dental setting: a feasibility study protocol

Cited by 3 publications

References 35 publications

Smokeless Tobacco Cessation Support in Dental Hospitals in Pakistan: Dentists and Dental Patients’ Perspectives on Current Practices, Support Needed, and Opportunities Available

Smokeless Tobacco Cessation Support in Dental Hospitals in Pakistan: Dentists and Dental Patients’ Perspectives on Current Practices, Support Needed, and Opportunities Available

Behavior Change Intervention for Smokeless Tobacco Cessation Delivered Through Dentists in Dental Settings: A Pragmatic Pilot Trial

Process evaluation of a pragmatic feasibility trial on smokeless tobacco cessation intervention delivered in dental hospitals

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