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Understanding implementation and feasibility of tobacco cessation in routine primary care in Nepal: a mixed methods study

Overview of attention for article published in Implementation Science, January 2016
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (77th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (58th percentile)

Mentioned by

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9 tweeters

Citations

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17 Dimensions

Readers on

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112 Mendeley
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Title
Understanding implementation and feasibility of tobacco cessation in routine primary care in Nepal: a mixed methods study
Published in
Implementation Science, January 2016
DOI 10.1186/s13012-016-0466-7
Pubmed ID
Authors

Helen Elsey, Sudeepa Khanal, Shraddha Manandhar, Dilip Sah, Sushil Chandra Baral, Kamran Siddiqi, James Nicholas Newell

Abstract

By 2030, 80 % of the annual 8.3 million deaths attributable to tobacco will be in low-income countries (LICs). Yet, services to support people to quit tobacco are not part of routine primary care in LICs. This study explored the challenges to implementing a behavioural support (BS) intervention to promote tobacco cessation within primary care in Nepal. The study used qualitative and quantitative methods within an action research approach in three primary health care centres (PHCCs) in two districts of Nepal. Before implementation, 21 patient interviews and two focus groups with health workers informed intervention design. Over a 6-month period, two researchers facilitated action research meetings with staff and observed implementation, recording the process and their reflections in diaries. Patients were followed up 3 months after BS to determine tobacco use (verified biochemically) and gain feedback on the intervention. A further five interviews with managers provided reflections on the process. The qualitative analysis used Normalisation Process Theory (NPT) to understand implementation. Only 2 % of out-patient appointments identified the patient as a smoker. Qualitative findings highlight patients' unwillingness to admit their smoking status and limited motivation among health workers to offer the intervention. Patient-centred skills needed for BS were new to staff, who found them challenging particularly with low-literacy patients (skill set workability). Heath workers saw cessation advice and BS as an addition to their existing workload (relational integration). While there was strong policy buy-in, operationalising this through reporting and supervision was limited (contextual integration). Of the 44 patients receiving the intervention, 27 were successfully followed up after 3 months; 37 % of these had quit (verified biochemically). Traditionally, primary health care in LICs has focused on acute care; with increasing recognition of the need for lifestyle change, health workers must develop new skills and relationships with patients. Appropriate and regular recording, reporting, supervision and clear leadership are needed if health workers are to take responsibility for smoking cessation. The consistent implementation of these health system activities is a requirement if cessation services are to be normalised within routine primary care.

Twitter Demographics

The data shown below were collected from the profiles of 9 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 112 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 112 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 17 15%
Researcher 15 13%
Student > Postgraduate 12 11%
Student > Ph. D. Student 10 9%
Unspecified 7 6%
Other 25 22%
Unknown 26 23%
Readers by discipline Count As %
Medicine and Dentistry 27 24%
Nursing and Health Professions 17 15%
Social Sciences 11 10%
Unspecified 7 6%
Psychology 7 6%
Other 14 13%
Unknown 29 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 31 May 2017.
All research outputs
#1,735,955
of 11,194,639 outputs
Outputs from Implementation Science
#536
of 1,194 outputs
Outputs of similar age
#59,725
of 264,868 outputs
Outputs of similar age from Implementation Science
#15
of 36 outputs
Altmetric has tracked 11,194,639 research outputs across all sources so far. Compared to these this one has done well and is in the 84th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,194 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 11.9. This one has gotten more attention than average, scoring higher than 54% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 264,868 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 77% of its contemporaries.
We're also able to compare this research output to 36 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 58% of its contemporaries.