title: Behaviour change intervention for smokeless tobacco (ST) cessation delivered by dentists in a dental setting: a feasibility study
Creators: name: Rasool, Shaista
Publisher: name: The University of Edinburgh
Year: 2024
Subjects: subject: smokeless tobacco
subject: tobacco
subject: cessation
subject: Dentistry
subject: FOS: Clinical medicine

description: BACKGROUND: Smokeless tobacco (ST) has been categorised as a group 1 carcinogen by the ‘international agency for cancer research’ (IARC) (1). The South- Asian region bears the greatest toll of ST-related mortalities (88%) and ST-related DALYS(80%) (2, 3). While there is convincing evidence on the effectiveness of ST cessation support delivered by dental professionals, most of the evidence comes from research conducted in high- income countries (4, 5). This limits the generalizability of such evidence to low and middle-income countries (LMICs), which share the greatest burden of ST use. This research aimed to assess the feasibility of delivering and investigating a structured behavioural intervention for ST cessation in dental settings in Pakistan. METHODS: A feasibility study comprising three phases was conducted. The first phase involved qualitative interviews with dental patients (n=12, who were ST users) and dentists (n=12) at two dental hospitals in Pakistan to inform the adaption of an existing behaviour support intervention for ST cessation. Data were analysed thematically (guided by the COM-B model). The second phase involved a multi-centre, pilot, 2-armed parallel group, individually randomised controlled trial, with a 1:1 allocation ratio at two tertiary level dental hospitals in Pakistan, to assess: eligibility, recruitment, retention rates and, feasibility of delivering the intervention and collection of data on ST use behaviour for future definitive trials. Eligibility criteria included: being a ST user; seeking dental treatment at the selected hospitals and; not currently accessing cessation support. All participants were provided with written self-help material on ST cessation. The intervention group received a structured behavioural support intervention for ST cessation from their dentist in three face-to-face sessions. Participants were followed up by telephone at three months and six months. Cotinine analysis of saliva samples was conducted for the participants who self-reported six-month abstinence. In order to explore the practicality and feasibility of delivering the intervention, a mixed method process evaluation (third phase) was conducted, which involved; qualitative interviews with trial participants (dental patients (n=13) and participating dentists (n=13) and; assessment of fidelity to intervention delivery by audio recording some of the intervention sessions (n=29). RESULTS: Patients expressed a strong desire to quit but were offered negligible cessation support. While dentists were aware of their role in ST cessation, they did not believe in the patients' need for support and cited a number of reasons behind their inability to offer cessation support in routine clinical practice. The most common reasons were: layout of clinical setting (lack of privacy); workload; lack of referral systems; fear of offending patients, and the absence of a mandatory requirement of offering ST cessation support. One hundred participants were successfully recruited from three departments of dentistry (periodontics, prosthodontics and endodontics) from each of the two selected hospitals. Sixty three (63%) of the participants completed the study (hospital) visits (64 % intervention vs 62% control) and 78% completed the six month follow up. The majority of the outcome measures were successfully collected. Self-reported six-month abstinence was 24% in the intervention group and 8% in the control group, with biochemically verified rates being 10% and 4% respectively. The intervention was found to be acceptable and perceived positively by patients and dentists. However, delivery of certain intervention components was poor. CONCLUSION: Data indicates that it is feasible to deliver and study a structured behaviour support intervention for ST cessation to dental patients via dentists within dental settings in Pakistan. Findings suggest improvement in ST quit rates with the intervention. The results of this study will be useful in informing the design of future definitive studies.