Figures
- FIGURE 1
Tool used in each phase. Meta-QAT: Meta Quality Appraisal Tool; CASP: Critical Appraisal Skills Programme; CFIR: Consolidated Framework for Implementation Research; GRADE-CERQual: Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research.
- FIGURE 2
Flow diagram of screening process.
- FIGURE 3
Study settings and interventions. Symbols with two colours indicate the study covered both interventions. Half a symbol means half of the study was conducted in this setting and the other half in another setting.
- FIGURE 4
Full overview of implementation factors per domain, and the relative level of evidence for the factor.
- FIGURE 5
Free Respiratory Evaluation and Smoke-exposure reduction by primary Health cAre Integrated gRoups (FRESH AIR) Implementation Tool. #: These suggestions are based on the literature specific for interventions targeting chronic respiratory disease in low- and middle-income countries, and on additional, general implementation literature. See Appendix 7 for recommended use of the tool and details on the references.
Tables
- TABLE 1
Characteristics of the included studies and critical appraisal, by author
First author [ref.] Study design Country Setting; population Intervention Summary of appraisal Rv R V A Aghi [49] # Qualitative study within an RCT India Public urban and rural schools; health educators, lead teachers and staff Tobacco cessation + − − ± Aldinger [65]¶ Qualitative (institutional ethnography) China Primary to vocational schools; administrators, staff, teachers, students, and parents Tobacco prevention within programme of health-promoting schools ± 1 ± ± + Aldinger [66]¶ Qualitative (institutional ethnography) China Primary to vocational schools; administrators, staff, teachers, students and parents Tobacco prevention within programme of health-promoting schools − + ± + Asfar [64] Qualitative study within an RCT Syria Primary healthcare setting; physicians and medical students Tobacco cessation + 1 − ? ± Assanangkornchai [82] Qualitative (action research) Thailand Primary healthcare setting; healthcare workers (nurses, administrators, directors) Tobacco, alcohol and substance use screening and brief intervention ± 1 ± ± + Bheekie [60] Qualitative study preparing for an RCT South Africa Primary healthcare setting; trained nurses, with a supervisory position as care coordinators Train-the-trainer programme on implementation of respiratory guidelines on (obstructive) lung diseases + + + ± Bteddini [63] Mixed-method, with quantitative survey and participatory approach for qualitative data Lebanon Seven public and seven private schools throughout the country; trained external facilitators training 10 sessions for 844 students Waterpipe smoking prevention/delay of starting to smoke ± 1 + + + Castaldelli-Maia [51] Qualitative Brazil Urban psychosocial care units (primary care) across the country; diverse health professionals (e.g. dentist, nurses, physicians, managers) Tobacco cessation + 1 ± ? ± Chatterjee [70] Qualitative India Rural villages; community members (programme managers, coordinators, health workers and stakeholders at village level) Tobacco-free village + 1 ± ± + Cruvinel [52] Quantitative, survey design (correlations) Brazil Urban, primary healthcare; 149 diverse workers (e.g. community health workers, nurses, physicians) Training on tobacco, alcohol and drug use screening and brief intervention ± + + ± Elsey [78] Mixed-method, factors derived from qualitative data (action research) Nepal Urban and rural primary healthcare; patients, healthcare providers, managers and policy makers Tobacco cessation, behaviour support + 1 + + + Goenka [71]+ Mixed-method study within an RCT India 32 Urban, public and private schools; professionals with a Master's degree in psychology, sociology or nutrition who taught teachers and peer leaders Tobacco prevention by teachers and peer-leaders ± + ± ± Groth-Marnat [85] Qualitative Fiji Traditional village; community members Tobacco cessation + 1 ± ? ± Ishaak [58] Mixed-method, factors derived from qualitative data Suriname Urban junior high school; management and teachers Tobacco and other drug prevention ± ± ± ± Khan [80] Mixed-method, embedded in RCT, factors derived from qualitative data Pakistan 30 Primary and secondary level public healthcare facilities; care providers (15 received intervention, interviews in 4 of the centres) Integrated COPD/asthma care + 1 + + + Malan [61] Qualitative South Africa Primary care practice; care providers (nurses and physicians) Brief behaviour change counselling (“5As”) for tobacco, diet, physical activity and alcohol abuse ± 1 + + + Marsiglia [57] Qualitative for the factors reported, within a quantitative study Mexico Urban public middle schools; teachers Tobacco and other substance use prevention ± − ? − Mash [62] Qualitative, prospective (outcome mapping) South Africa Urban and rural, primary care to specialised care with a focus on the public sector; doctors, clinical nurse practitioners, pharmacists, National Council for Medical Schemes, the Department of Health, universities and training bodies patients Asthma-guideline implementation and dissemination + 1 ± ? ± McAlister [81] Qualitative for the factors reported, within a quantitative study Russia Community level; hospital staff, intervention for community smokers Stop smoking campaign + ± ? ± Medeiros [53] Mixed-methods, factors derived from qualitative data Brazil Urban schools; teachers, school administrators, coaches, other stakeholders (e.g. municipality) and students Tobacco prevention within a drug use prevention programme ± + + + Mehanni [79] Qualitative Nepal Small rural hospital (managed through a public-private partnership) Quality improvement initiative for management of COPD + − ? ± Melson [77] Mixed-methods within pilot RCT; factors derived from qualitative data (quantitative data n.a., regard hypothetic factors prior to implementation). Pro- and retrospective Malaysia Secondary school; students Peer-led anti-smoking intervention (smoke-free class) + 1 + + + Nagler [72]# Qualitative, formative pilot study preparing for an RCT India One public urban and one rural school, not included in the RCT; health educators and teachers Tobacco cessation – school based ± + + ± Nichter [73] Qualitative India & Indonesia Lead public & private medical schools and outreach to their communities Training network for tobacco prevention (curricula), outreach and clinic on smoking cessation + 1 − ? ± Ossip [56] Qualitative (Rapid Assessment Process) Dominican Republic Urban, peri-urban & rural communities with active Community Technology Centers; a multidisciplinary team including specialists of psychology, anthropology, nursing, epidemiology, statistics and public health (from the US) and medicine (DR) Tobacco cessation – participatory approach + 1 ± ? ± Pawar [50]# Qualitative factors reported within a quantitative study, embedded in an RCT India 72 Public urban and rural schools; health educators, lead teachers and staff Tobacco cessation - lay interventionist teaching teachers ± − ? − Pereira [54] Quantitative, population-based cross-sectional survey design Brazil Urban public and private schools; 263 school managers (headmasters, pedagogical coordinators, coordinators of the prevention programmes) Tobacco prevention within a drug use prevention programme ± 1 + ± ± Perry [74]+ Qualitative study (translational research) within an RCT following translational research India 32 urban schools, half were public and half were private; school administration, teachers, and peer-leaders Tobacco prevention ± 1 − ? ± Persai [75] Qualitative India At district level; senior district officials Tobacco control ± 1 + + + Portes [55] Qualitative, retrospective Brazil Urban primary healthcare units in a medium-sized municipality; municipal programme coordinator, and senior health professionals trained on smoking cessation or local managers Tobacco control – training healthcare professionals on facilitating treatment & prevention activities (Furthermore, interventions on governmental level, n.a. to our study) + 1 + + + Prasodjo [76] Mixed-method, factors derived from qualitative data (amongst which participatory action research) Indonesia Rural community; local institutions (policy makers, medical staff, community leaders and other stakeholders) Post-partum smoke (‘Sei’) traditions – Behavioural change communication campaign targeting household air pollution + − ± ± Rosati [83] Mixed-methods, factors derived from qualitative data Thailand Urban family setting; health educators towards families Tobacco, alcohol and other substance abuse prevention, sex education ± 1 ± ± ± Sodhi [59] Mixed-methods, factors derived from qualitative data Malawi 30 urban and rural, government-funded and non-government funded health centres; primary healthcare workers: clinical officers, medical assistants, and nurses Train-the-trainer on guideline use for providing integrated primary lung healthcare ± 1 ± ± + Vitavasiri [84] Quantitative questionnaire Thailand 676 Thai hospitals; personnel Smoke-free hospitals + 1 − ? − Wang [67] Qualitative China County-level hospitals; health professionals, hospital president, director of preventive health, representatives of the hospitals Smoke-free hospitals + 1 + + + Xiao [68] Mixed-method, factors concerned qualitative data China 41 Hospital across the country, the majority from a tobacco control network; medical doctors and directors Smoke-free hospitals ± 1 − ? + Ziedonis [69] Qualitative China Hospital-based mental health centre; personnel and patients Smoke-free hospitals + 1 − ? ± Studies were prospective unless otherwise indicated. Rv: relevance; R: reliability; V: validity; A: applicability to a wider public health context. RCT=randomised controlled trial. Scored in appraisal as: +: high; ±: medium; −
: low; ?: unclear. Relevance '1': Evaluation of implementation was a primary outcome of the article. Articles with matching footnote indicators are from the same study. #: findings from Aghi et al. were excluded from the analysis, as Pawar et al. based their findings on the same study data and had higher appraisal scores. Nagler et al. based findings on a different study data (pilot study) and was included. +: findings from both studies were included as these were based on different study data.
Supplementary Material
Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
Supplementary material ERJ-00127-2020.Supplement
Supplementary Material
This one-page PDF can be shared freely online.
Shareable PDF ERJ-00127-2020.Shareable
