Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): study protocol for a cluster randomised controlled trial of a community-based smoke-free homes intervention, with or without Indoor Air Quality feedback

Abstract

BackgroundSecond-hand smoke (SHS) is a serious health hazard costing 890,000 lives a year globally. Women and children in many economically developing countries are worst affected as smoke-free laws are only partially implemented and homes remain a major source of SHS exposure. There is limited evidence on interventions designed to reduce SHS exposure in homes, especially in community settings. Following a successful pilot, a community-based approach to promote smoke-free homes in Bangladesh, a country with a strong commitment to smoke-free environments but with high levels of SHS exposure, will be evaluated. The study aims to assess the effectiveness and cost-effectiveness of a community-based intervention, Muslims for better Health (M4bH), with or without Indoor Air Quality (IAQ) feedback, in reducing non-smokers’ exposure to SHS in the home.Methods/designBased on behaviour-change theories, M4bH and IAQ feedback are designed to discourage people from smoking indoors. M4bH consists of a set of messages couched within mainstream Islamic discourse, delivered weekly by faith leaders (imams and khatibs) in mosques over 12 weeks (one message each week). The messages address key determinants of current smoking behaviours including lack of knowledge and misconceptions on specific harms associated with SHS exposure. IAQ feedback consists of personalised information on IAQ measured by a particulate matter (PM2.5) monitor within the home. Following adaptation of M4bH and IAQ feedback for the Bangladeshi context, a three-arm cluster randomised controlled trial will be conducted in Dhaka. Forty-five mosques and 1800 households, with at least one smoker and one non-smoker, will be recruited. Mosques will be randomised to: M4bH and IAQ feedback; M4bH alone; or usual services only. The primary outcome is 24-h mean household concentration of indoor fine particulate matter (PM2.5) at 12 months post randomisation. Secondary outcomes are 24-h mean household PM2.5 at 3 months post randomisation, frequency and severity of respiratory symptoms, health care service use and quality of life. A cost-effectiveness analysis and process evaluation will also be conducted.DiscussionThe MCLASS II trial will test the potential of a community-based intervention to reduce second-hand smoke exposure at home and improve lung health among non-smokers in Bangladesh and beyond.Trial registrationISRCTN, ISRCTN49975452. Registered on 11 January 2018.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3100-y) contains supplementary material, which is available to authorized users.

Fathers’ Views and Experiences of Creating a Smoke-Free Home: A Scoping Review

“…A second approach that has shown initial promise is currently being trialled in Bangladesh to evaluate the effectiveness of a community-based intervention to reduce SHS exposure at home, primarily targeting men via mosques [48]. This cluster RCT is based on the findings of a pilot trial that concluded that a smoke-free home intervention was acceptable to Muslim communities, and feasible to deliver in mosques [49,50].…”

“…This cluster RCT is based on the findings of a pilot trial that concluded that a smoke-free home intervention was acceptable to Muslim communities, and feasible to deliver in mosques [49,50]. If found to be effective in changing smoking behaviour in the home, this approach could be generalizable to other communities with similar male smoking norms where faith-based settings (i.e., churches, mosques, synagogues) play an integral part in their lives [48].…”

Diurnal variability of fine-particulate pollution concentrations: data from 14 low- and middle-income countries

“…The recent availability of low-cost particle counting monitors has also made it possible to assess concentrations of PM more widely, both indoors and outdoors. As part of the MCLASS II (Muslim Communities Learning About Second-hand Smoke in Bangladesh) study, 15 a trial of a novel smoke-free homes intervention, 24 h measurements of indoor PM were made in 1,801 homes around Dhaka, Bangladesh, using one such monitor, the Dylos DC1700 particle counter (Dylos Corp, Riverside, CA, USA). These data included 779 homes where smoking was not reported to take place.…”

Indoor air quality prediction systems for smart environments: A systematic review

“…Finally, one study each was included from other countries as mentioned in Table 2. However, no study from other developing countries such as India, Nepal and Bangladesh that are greatly affected by IAP due to inadequate ventilation arrangements were included [13,42,48,53,83,100]. As the majority of the population in these countries use biomass fuels for cooking and heating purpose, the researchers in these locations need to show an active participation in the development of some potential IAQ monitoring and prediction systems that can provide more accurate results based on specific geographic conditions and pollutant concentrations [61,85,138].…”