||5R01CA248910-02 Interpret this number
||Dana-Farber Cancer Inst
||Scaling Up Tobacco Control in India: Comparing Smartphone to in-Person Training for Implementing an Evidence-Based Intervention to Reduce Tobacco Use Among Schoolteachers
Project Summary: Tobacco-related deaths are rising rapidly in low and middle-income countries (LMICs). In
India alone, tobacco use accounts for over 1.2 million deaths each year. Reducing these deaths will require
large-scale implementation of evidence-based interventions (EBIs) that promote tobacco use cessation.
However, given the limited reach and logistical challenges of conducting in-person training to implement
tobacco-control EBIs, new models are needed that can be implemented more broadly, flexibly and at low cost.
Until such robust tobacco-control EBIs are implemented and scaled, tobacco-related mortality will continue to
rise. Our long-term goal is to identify effective, low-resource strategies to promote broad-based implementation
of tobacco-control EBIs in LMICs. This study builds on an intervention for schoolteachers, called the Tobacco
Free Teachers, Tobacco Free Society (TFT-TFS) program, shown to be efficacious in increasing tobacco use
cessation in a cluster-randomized trial. Teachers in India are an important channel for promoting tobacco
control, given their roles as community leaders and role models. A critical next step in this research, which is our
objective here, is to compare the implementation and effectiveness of the TFT-TFS program when delivered
through in-person training verses a smartphone-based training model. Use of smartphones in educational
settings is already pervasive in India offering a readily available, low-cost strategy for expanding training on the
TFT-TFS program. By delivering TFT-TFS training through smartphones, the potential reach of the program
can be multiplied over what can be achieved with in-person training. We will conduct a comparative
effectiveness trial using a cluster-randomized design in which headmasters of schools in the Indian state of
Madhya Pradesh will be randomly assigned to receive in-person training or training via smartphone for the
TFT-TFS program. Once trained, headmasters in both groups will implement the TFT-TFS program within their
schools. We will compare the training arms in terms of program implementation, effectiveness, cost, and reach.
This Hybrid III study will be guided by the Consolidated Framework for Implementation Research and RE-AIM
Framework; we will use mixed methods to analyze factors contributing to outcomes. Accordingly, our specific
aims are to: (1) develop in-person and smartphone-based training models based on systematic assessment of
contextual factors in Madhya Pradesh; (2) compare program implementation fidelity, effectiveness, and cost for
the two training models; and (3) identify factors affecting program implementation after in-person vs.
smartphone-based training using a mixed-methods design. This project is innovative by shifting the status quo
from costly, time-intensive, in-person training to a smartphone-based training model to scale up tobacco
control EBIs. The proposed research is significant because it introduces a new approach for reducing tobacco
use and related deaths and demonstrates how training via smartphone can be applied to scaling other public
health-related EBIs in resource-constrained areas.