Phone Enabled Implementation of Cessation Support (PHOENICS)

Background

The tobacco use burden in Lebanon is exceptionally high: 35% of adults are current cigarette smokers and 39% are current waterpipe smokers and 5% are dual smokers. The WHO endorses three interventions as the standard of practice for population-level tobacco dependence treatment: smoking cessation advice integrated into primary care settings; easily-accessible phone-based counseling; and low-cost nicotine replacement therapy (NRT). However, the evidence for these interventions comes primarily from high-income countries and they have rarely been evaluated in low- and middle-income countries (LMICs). Further, recommended interventions are not integrated as a routine part of primary care in Lebanon, as is the case in other low-resource settings.

Aims

The objective of this project is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based cessation treatment in Lebanon’s national system of primary healthcare centers, which serves more than 50% of the population. Addressing this evidence-to-practice gap requires research on multilevel interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings.

Project plan

We will conduct a group-randomized trial comparing three arms:

1. Ask about tobacco use, advise to quit, assist with brief counseling (AAA) as standard care;

2. Ask, advise, connect to phone-based counseling (AAC); and

3. AAC+NRT.

Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. Our hybrid design is informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework which emphasizes key steps and multilevel factors to optimize implementation success. We will pursue the following specific aims:

1. adapt and tailor an existing smoking cessation program to deliver phone-based counseling to smokers in Lebanon;

2. test the effectiveness and cost-effectiveness of a referral-based program that delivers smoking cessation services to primary care patients; and

3. identify the multilevel determinants of implementation and sustainability using mixed methods. The proposed project addresses the evidence-to- practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually-tailored multilevel interventions and optimizing implementation success and sustainability.

This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings thereby reducing tobacco-related morbidity and mortality.

Funding organisations

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