A multicomponent intervention to reduce home-exposure to second-hand smoke (SHS) during pregnancy and postnatal period: a randomised controlled trial

Lead Research Organisation: University of Liverpool
Department Name: Institute of Psychology Health & Society

Abstract

South Asia has one of the highest numbers of male smokers anywhere in the world. As a result, over a third of pregnant women in South Asia are exposed to second-hand smoke in their homes. This has serious health consequences for both mothers (such as increased heart- and lung-related illnesses) as well as the newborn (higher chances of stillbirth, being born prematurely and lung-related illnesses). On the other hand, the antenatal period provides a window of opportunity to change health-related behaviours in the entire family. Interventions that are effective in reducing the exposure of pregnant women to second-hand smoke have been tried successfully in richer countries but have not been adapted for large-scale implementation in lower and middle-income countries.

Our proposed project addresses this gap in two such countries - urban Bangalore, India and peri-urban Comilla, Bangladesh. The sites are situated in a region with the greatest burden of disease from the effects of second-hand smoke globally. The project has two broad aims: The first is to adapt existing knowledge about what is known to work, into an acceptable and feasible intervention that can be delivered to the woman and her family members. This may include informing the woman and her family about the levels of second-hand smoke in her body measured by a simple test on her saliva; educating the whole family about the harmful effects of second-hand smoke on the mother and baby; and using 'communication-techniques' from the field of psychology and behavioural sciences to encourage husband and other family members to change the habit of smoking in the pregnant mother's presence. The second aim is to apply scientific methods to test the effectiveness of this intervention in reducing the exposure of pregnant women and newborn to second-hand smoke in both sites, and to determine the costs versus benefits of implementing such an intervention.

The project will be undertaken in two phases. In Phase 1 (Development Phase: Months 0-12), we will interview pregnant women, their husbands, and other family members to gain an in-depth understanding of all the issues surrounding the problem of second-hand smoke in the household, including barriers we may face in trying to change this. We will use this information to develop an intervention that can overcome these barriers in an acceptable way. During this phase, we will also help our Indian and Bangladeshi counterparts gain the expertise needed to develop such interventions, and in scientific methods to test them. In Phase 2 (Trial Phase - Months 13-36), we will conduct a strict scientific experiment (called a randomized controlled trial) to compare our new intervention with education about second-hand smoke through a leaflet. We will identify 920 mothers in early pregnancy, who are exposed to second hand smoke at home (460 at each site), to receive either the intervention or only the educational leaflet. This will be done in a way that each woman has an equal chance of being in either group. We will collect information on all these mothers and families when we recruit them into our study and then in late-pregnancy, 3 months after both groups have received either of the two interventions. We will also collect information when the new baby is born, and then 3 months after his/her birth. The information collected will include how the pregnancy and birth fared; levels of second-hand smoke in the mothers' and infants' body through a test on their saliva; health of both mother and baby, and smoking behaviours of family members. We will compare the information collected in the two groups to see how well the intervention did. We will also collect more detailed information from some families to understand how the intervention worked (or failed to work, in some cases).

The findings from the study will be shared with key academic, policy and community stakeholders throughout the duration of the project.

Technical Summary

Over a third of pregnant women in South Asia are exposed to second-hand smoke (SHS) in their homes with serious health consequences for themselves (increased cardiovascular and respiratory illnesses) as well as their new-borns (stillbirth, prematurity, and increased risk of respiratory illnesses). Interventions with proven efficacy exist but have not been tested at a population level in low- and middle-income countries. Our proposed project addresses this gap in in urban Bangalore, India and peri-urban Comilla, Bangladesh, sites situated in a region with the greatest burden of disease from SHS globally. The broad aims of this project are, a) to adapt existing evidence-based strategies (maternal cotinine feedback; cognitive-behavioural and motivation-enhancement strategies to engage husband and family; education) into a culturally appropriate, feasible multicomponent intervention, and; b) to evaluate its effectiveness and cost-effectiveness in reducing SHS exposure during pregnancy and postnatal period.
The project has two phases. In Phase 1 (Development Phase: Months 0-12), qualitative studies in both sites with key stakeholders (women, husbands and family-members) will inform the adaptation and piloting of the intervention strategies and build local research capacity. In Phase 2 (Trial Phase - Months 13-36), a single blind two arm two-site randomised controlled trial (RCT) will be conducted. We will randomize 920 women identified in early pregnancy who screen positive for exposure to SHS (460 at each site), to either receive the multicomponent intervention or only health education delivered through a leaflet. Outcomes will be measured at baseline, late antenatal, birth, and 3 months postnatal and include mother and infant salivary cotinine levels, pregnancy outcomes, infant respiratory symptoms, service utilization, health related quality of life, and smoking behaviours within the household. Process evaluation will help understand fidelity and feasibility issues.

Planned Impact

We anticipate impact in three areas: 1) Advancements in the field of interventions to reduce exposure to second hand smoke (SHS) in mothers and infants; 2) Capacity building of Indian and Bangladeshi researchers; and, 3) Public health and policy strategies to improve maternal and child health. (See also Pathways to Impact statement).

The multidisciplinary team drawn from psychological sciences, public health, and smoking cessation will combine strategies from their respective fields to develop innovative interventions to reduce exposure to SHS that are tailored to the South Asian context. The intervention will be designed with the potential for integration and scale-up. The strategies have the potential to be applied to other areas of public health where modification of household behavior is desired.

The project will lead to the development of capacity in Indian researchers to adapt interventions and conduct trials of complex interventions. This will be achieved through engagement of local research teams with experts in the UK, and through a series of workshops integrated into the study.

We plan to achieve maximum policy impact by actively engaging academic as well as non-academic beneficiaries (national and global health policy organizations, families, the wider community, the voluntary sector and the media) through our existing links with such bodies, thereby raising public awareness and understanding of the harmful effects of SHS and achieving public health and policy change.
 
Description Presentation at the International Association for Women's Mental Health (IAWMH) conference, 5-8 March 2019, Paris, France
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact The findings from our research provided this audience of academicians, researchers and implementers a feasible and promising solution to reducing second-hand smoking in pregnant women. Very few interventions have been tested in low and middle income countries to address this public health problem.
 
Description Presentation at the Marce Society International Conference on Perinatal Mental Health
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact The Marce Society is one of the most influential international organisations concerned with the well-being of women and children in the perinatal period. This presentation given to an audience of over 500 academics, policy makers and researchers introduced the intervention and the early findings to the audience. It generated great interest.
 
Description Presentation to NIMHANS key academicians and practitioners
Geographic Reach Asia 
Policy Influence Type Influenced training of practitioners or researchers
Impact The early results of the intervention in reducing second-hand smoking in pregnant women was made to key academicians and practitioners at the National Institute of Mental Health and Neurosciences. There was great interest in scaling-up / promoting the intervention following further trials. This local interest and engagement is important for future plans of conducting further research and obtaining buy-in from key decision makers.
 
Description University of Liverpool India Fellowship Programme 16/17
Amount £5,000 (GBP)
Organisation University of Liverpool 
Sector Academic/University
Country United Kingdom
Start 09/2017 
End 12/2017
 
Title MLASS Survey tool 
Description We developed a questionnaire to assess exposure to second hand smoke in pregnancy. This tool is now being adapted to be used in the new MRC funded project 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2015 
Provided To Others? Yes  
Impact Not yet, as this tool is still being adapted for the new research project 
 
Description IMPRESS collaboration 
Organisation ARK Foundation Bangladesh
Country Bangladesh 
Sector Charity/Non Profit 
PI Contribution Our UK team is working in collaboration with the local teams in India and Bangladesh, where field work is being carried out. We have identified the research area and developed the key research questions. We helped local teams in developing the research grant application and Identify appropriate local partners. So far our team and collaborators conducted four workshops, three in Dhaka for i) proposal development ii) analysis of qualitative data and iii) development of intervention, and one in Liverpool to plan the fieldwork. For the last workshop in Dhaka (Feb 2016) our group carried out a systematic review to inform about the intervention used by other researchers to reduce the secondhand smoke exposure to pregnant women. We also shared our knowledge and experience of behavioral change techniques that have been used in our previous similar research projects. We are also helping local teams to develop SOPs for the pilot trial.
Collaborator Contribution York University is helping to carry out qualitative research component to enhance capacity of local teams. In the intervention development workshop they trained local teams analyse in-depth interview data to inform formative research. The York University team also contributed to the other components of research for the development of intervention. The NIMHANS and ARK Foundation teams have brought local knowledge and cultural aspects to modulate intervention in addition to contribute to intervention development based on their previous experience. NIMHANS and ARK foundation also brought local collaborators to finalise the intervention and helped identify study centres for the pilot trial. NIMHANS has a well reputed laboratory to carry out saliva cotinine anlaysis. They have standardised the procedure and developed a SOP for this purpose.
Impact 1. Successful grant application: This collaboration has successfully secured MRC-DBT collaboration funding for next one and half year to develop and pilot an intervention to reduce second-hand smoke (SHS) exposure in pregnant women. 2. Building capacity to analyse qualitative data: In-depth interviews carried out to assess knowledge regarding SHS hazards, and preference of intervention to reduce SHS exposure. In total 67 interviews with pregnant women, husbands and family members who smoke at home and husbands who do not smoke at home or do not smoke at all were carried out. The data was analysed using Nvivo software. The University of York led capacity building exercise helped local teams understand the analysis methodology and use software. Currently both teams are analysing data independently with regular input from the York team. 3. Systematic review: A systematic Review was carried out to assess type of interventions used in similar situations in which pregnant women were the agents of change to reduce their exposure to secondhand smoke. 4. Expert opinion: Experts in the area of smoking cessation related field were contacted and asked to provide rating for the selected behavioural change techniques using a modified Delphi technique. 5. Finalsation of intervention: During last workshop of researchers, using detailed deliberation and consensus development, finalised interventions based on qualitative data, systematic review and expert opinion. The local teams have developed first draft of the intervention keeping in mind cultural sensitivity and local norms based on their previous experience and knowledge. 6. SOP for saliva cotinine assessment: with the help of York University, the NIMHANS is using state of the art technology to assess saliva cotinine. They have developed SOP for this purpose and are currently standardising the procedure. The collaboration is multi-disciplinary: The University of Liverpool: Psychiatry, theory based Behavioural techniques, public health, epidemiology and clinical trial expertise The University of York: Behavioural Techniques for cigarette smoking reduction/quitting, qualitative research, public health, health economics NIMHANS: Psychiatry, psychology, public health, field epidemiology ARK foundation: Health economics, public health, field epidemiology LSTM: Clinical Trial; statistics RTI, International: Environmental exposure assessment The Healis-Sekhsaria Institute: Health policy IIIT - Delhi: IT related activities including setting up electronic database, and 'voice messaging', one of the key component of intervention package.
Start Year 2015
 
Description IMPRESS collaboration 
Organisation Healis-Sekhsaria Institute for Public Health
Country India 
Sector Academic/University 
PI Contribution Our UK team is working in collaboration with the local teams in India and Bangladesh, where field work is being carried out. We have identified the research area and developed the key research questions. We helped local teams in developing the research grant application and Identify appropriate local partners. So far our team and collaborators conducted four workshops, three in Dhaka for i) proposal development ii) analysis of qualitative data and iii) development of intervention, and one in Liverpool to plan the fieldwork. For the last workshop in Dhaka (Feb 2016) our group carried out a systematic review to inform about the intervention used by other researchers to reduce the secondhand smoke exposure to pregnant women. We also shared our knowledge and experience of behavioral change techniques that have been used in our previous similar research projects. We are also helping local teams to develop SOPs for the pilot trial.
Collaborator Contribution York University is helping to carry out qualitative research component to enhance capacity of local teams. In the intervention development workshop they trained local teams analyse in-depth interview data to inform formative research. The York University team also contributed to the other components of research for the development of intervention. The NIMHANS and ARK Foundation teams have brought local knowledge and cultural aspects to modulate intervention in addition to contribute to intervention development based on their previous experience. NIMHANS and ARK foundation also brought local collaborators to finalise the intervention and helped identify study centres for the pilot trial. NIMHANS has a well reputed laboratory to carry out saliva cotinine anlaysis. They have standardised the procedure and developed a SOP for this purpose.
Impact 1. Successful grant application: This collaboration has successfully secured MRC-DBT collaboration funding for next one and half year to develop and pilot an intervention to reduce second-hand smoke (SHS) exposure in pregnant women. 2. Building capacity to analyse qualitative data: In-depth interviews carried out to assess knowledge regarding SHS hazards, and preference of intervention to reduce SHS exposure. In total 67 interviews with pregnant women, husbands and family members who smoke at home and husbands who do not smoke at home or do not smoke at all were carried out. The data was analysed using Nvivo software. The University of York led capacity building exercise helped local teams understand the analysis methodology and use software. Currently both teams are analysing data independently with regular input from the York team. 3. Systematic review: A systematic Review was carried out to assess type of interventions used in similar situations in which pregnant women were the agents of change to reduce their exposure to secondhand smoke. 4. Expert opinion: Experts in the area of smoking cessation related field were contacted and asked to provide rating for the selected behavioural change techniques using a modified Delphi technique. 5. Finalsation of intervention: During last workshop of researchers, using detailed deliberation and consensus development, finalised interventions based on qualitative data, systematic review and expert opinion. The local teams have developed first draft of the intervention keeping in mind cultural sensitivity and local norms based on their previous experience and knowledge. 6. SOP for saliva cotinine assessment: with the help of York University, the NIMHANS is using state of the art technology to assess saliva cotinine. They have developed SOP for this purpose and are currently standardising the procedure. The collaboration is multi-disciplinary: The University of Liverpool: Psychiatry, theory based Behavioural techniques, public health, epidemiology and clinical trial expertise The University of York: Behavioural Techniques for cigarette smoking reduction/quitting, qualitative research, public health, health economics NIMHANS: Psychiatry, psychology, public health, field epidemiology ARK foundation: Health economics, public health, field epidemiology LSTM: Clinical Trial; statistics RTI, International: Environmental exposure assessment The Healis-Sekhsaria Institute: Health policy IIIT - Delhi: IT related activities including setting up electronic database, and 'voice messaging', one of the key component of intervention package.
Start Year 2015
 
Description IMPRESS collaboration 
Organisation Indraprastha Institute of Information Technology Delhi
Country India 
Sector Academic/University 
PI Contribution Our UK team is working in collaboration with the local teams in India and Bangladesh, where field work is being carried out. We have identified the research area and developed the key research questions. We helped local teams in developing the research grant application and Identify appropriate local partners. So far our team and collaborators conducted four workshops, three in Dhaka for i) proposal development ii) analysis of qualitative data and iii) development of intervention, and one in Liverpool to plan the fieldwork. For the last workshop in Dhaka (Feb 2016) our group carried out a systematic review to inform about the intervention used by other researchers to reduce the secondhand smoke exposure to pregnant women. We also shared our knowledge and experience of behavioral change techniques that have been used in our previous similar research projects. We are also helping local teams to develop SOPs for the pilot trial.
Collaborator Contribution York University is helping to carry out qualitative research component to enhance capacity of local teams. In the intervention development workshop they trained local teams analyse in-depth interview data to inform formative research. The York University team also contributed to the other components of research for the development of intervention. The NIMHANS and ARK Foundation teams have brought local knowledge and cultural aspects to modulate intervention in addition to contribute to intervention development based on their previous experience. NIMHANS and ARK foundation also brought local collaborators to finalise the intervention and helped identify study centres for the pilot trial. NIMHANS has a well reputed laboratory to carry out saliva cotinine anlaysis. They have standardised the procedure and developed a SOP for this purpose.
Impact 1. Successful grant application: This collaboration has successfully secured MRC-DBT collaboration funding for next one and half year to develop and pilot an intervention to reduce second-hand smoke (SHS) exposure in pregnant women. 2. Building capacity to analyse qualitative data: In-depth interviews carried out to assess knowledge regarding SHS hazards, and preference of intervention to reduce SHS exposure. In total 67 interviews with pregnant women, husbands and family members who smoke at home and husbands who do not smoke at home or do not smoke at all were carried out. The data was analysed using Nvivo software. The University of York led capacity building exercise helped local teams understand the analysis methodology and use software. Currently both teams are analysing data independently with regular input from the York team. 3. Systematic review: A systematic Review was carried out to assess type of interventions used in similar situations in which pregnant women were the agents of change to reduce their exposure to secondhand smoke. 4. Expert opinion: Experts in the area of smoking cessation related field were contacted and asked to provide rating for the selected behavioural change techniques using a modified Delphi technique. 5. Finalsation of intervention: During last workshop of researchers, using detailed deliberation and consensus development, finalised interventions based on qualitative data, systematic review and expert opinion. The local teams have developed first draft of the intervention keeping in mind cultural sensitivity and local norms based on their previous experience and knowledge. 6. SOP for saliva cotinine assessment: with the help of York University, the NIMHANS is using state of the art technology to assess saliva cotinine. They have developed SOP for this purpose and are currently standardising the procedure. The collaboration is multi-disciplinary: The University of Liverpool: Psychiatry, theory based Behavioural techniques, public health, epidemiology and clinical trial expertise The University of York: Behavioural Techniques for cigarette smoking reduction/quitting, qualitative research, public health, health economics NIMHANS: Psychiatry, psychology, public health, field epidemiology ARK foundation: Health economics, public health, field epidemiology LSTM: Clinical Trial; statistics RTI, International: Environmental exposure assessment The Healis-Sekhsaria Institute: Health policy IIIT - Delhi: IT related activities including setting up electronic database, and 'voice messaging', one of the key component of intervention package.
Start Year 2015
 
Description IMPRESS collaboration 
Organisation Liverpool School of Tropical Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Our UK team is working in collaboration with the local teams in India and Bangladesh, where field work is being carried out. We have identified the research area and developed the key research questions. We helped local teams in developing the research grant application and Identify appropriate local partners. So far our team and collaborators conducted four workshops, three in Dhaka for i) proposal development ii) analysis of qualitative data and iii) development of intervention, and one in Liverpool to plan the fieldwork. For the last workshop in Dhaka (Feb 2016) our group carried out a systematic review to inform about the intervention used by other researchers to reduce the secondhand smoke exposure to pregnant women. We also shared our knowledge and experience of behavioral change techniques that have been used in our previous similar research projects. We are also helping local teams to develop SOPs for the pilot trial.
Collaborator Contribution York University is helping to carry out qualitative research component to enhance capacity of local teams. In the intervention development workshop they trained local teams analyse in-depth interview data to inform formative research. The York University team also contributed to the other components of research for the development of intervention. The NIMHANS and ARK Foundation teams have brought local knowledge and cultural aspects to modulate intervention in addition to contribute to intervention development based on their previous experience. NIMHANS and ARK foundation also brought local collaborators to finalise the intervention and helped identify study centres for the pilot trial. NIMHANS has a well reputed laboratory to carry out saliva cotinine anlaysis. They have standardised the procedure and developed a SOP for this purpose.
Impact 1. Successful grant application: This collaboration has successfully secured MRC-DBT collaboration funding for next one and half year to develop and pilot an intervention to reduce second-hand smoke (SHS) exposure in pregnant women. 2. Building capacity to analyse qualitative data: In-depth interviews carried out to assess knowledge regarding SHS hazards, and preference of intervention to reduce SHS exposure. In total 67 interviews with pregnant women, husbands and family members who smoke at home and husbands who do not smoke at home or do not smoke at all were carried out. The data was analysed using Nvivo software. The University of York led capacity building exercise helped local teams understand the analysis methodology and use software. Currently both teams are analysing data independently with regular input from the York team. 3. Systematic review: A systematic Review was carried out to assess type of interventions used in similar situations in which pregnant women were the agents of change to reduce their exposure to secondhand smoke. 4. Expert opinion: Experts in the area of smoking cessation related field were contacted and asked to provide rating for the selected behavioural change techniques using a modified Delphi technique. 5. Finalsation of intervention: During last workshop of researchers, using detailed deliberation and consensus development, finalised interventions based on qualitative data, systematic review and expert opinion. The local teams have developed first draft of the intervention keeping in mind cultural sensitivity and local norms based on their previous experience and knowledge. 6. SOP for saliva cotinine assessment: with the help of York University, the NIMHANS is using state of the art technology to assess saliva cotinine. They have developed SOP for this purpose and are currently standardising the procedure. The collaboration is multi-disciplinary: The University of Liverpool: Psychiatry, theory based Behavioural techniques, public health, epidemiology and clinical trial expertise The University of York: Behavioural Techniques for cigarette smoking reduction/quitting, qualitative research, public health, health economics NIMHANS: Psychiatry, psychology, public health, field epidemiology ARK foundation: Health economics, public health, field epidemiology LSTM: Clinical Trial; statistics RTI, International: Environmental exposure assessment The Healis-Sekhsaria Institute: Health policy IIIT - Delhi: IT related activities including setting up electronic database, and 'voice messaging', one of the key component of intervention package.
Start Year 2015
 
Description IMPRESS collaboration 
Organisation National Institute of Mental Health and Neurosciences
Country India 
Sector Hospitals 
PI Contribution Our UK team is working in collaboration with the local teams in India and Bangladesh, where field work is being carried out. We have identified the research area and developed the key research questions. We helped local teams in developing the research grant application and Identify appropriate local partners. So far our team and collaborators conducted four workshops, three in Dhaka for i) proposal development ii) analysis of qualitative data and iii) development of intervention, and one in Liverpool to plan the fieldwork. For the last workshop in Dhaka (Feb 2016) our group carried out a systematic review to inform about the intervention used by other researchers to reduce the secondhand smoke exposure to pregnant women. We also shared our knowledge and experience of behavioral change techniques that have been used in our previous similar research projects. We are also helping local teams to develop SOPs for the pilot trial.
Collaborator Contribution York University is helping to carry out qualitative research component to enhance capacity of local teams. In the intervention development workshop they trained local teams analyse in-depth interview data to inform formative research. The York University team also contributed to the other components of research for the development of intervention. The NIMHANS and ARK Foundation teams have brought local knowledge and cultural aspects to modulate intervention in addition to contribute to intervention development based on their previous experience. NIMHANS and ARK foundation also brought local collaborators to finalise the intervention and helped identify study centres for the pilot trial. NIMHANS has a well reputed laboratory to carry out saliva cotinine anlaysis. They have standardised the procedure and developed a SOP for this purpose.
Impact 1. Successful grant application: This collaboration has successfully secured MRC-DBT collaboration funding for next one and half year to develop and pilot an intervention to reduce second-hand smoke (SHS) exposure in pregnant women. 2. Building capacity to analyse qualitative data: In-depth interviews carried out to assess knowledge regarding SHS hazards, and preference of intervention to reduce SHS exposure. In total 67 interviews with pregnant women, husbands and family members who smoke at home and husbands who do not smoke at home or do not smoke at all were carried out. The data was analysed using Nvivo software. The University of York led capacity building exercise helped local teams understand the analysis methodology and use software. Currently both teams are analysing data independently with regular input from the York team. 3. Systematic review: A systematic Review was carried out to assess type of interventions used in similar situations in which pregnant women were the agents of change to reduce their exposure to secondhand smoke. 4. Expert opinion: Experts in the area of smoking cessation related field were contacted and asked to provide rating for the selected behavioural change techniques using a modified Delphi technique. 5. Finalsation of intervention: During last workshop of researchers, using detailed deliberation and consensus development, finalised interventions based on qualitative data, systematic review and expert opinion. The local teams have developed first draft of the intervention keeping in mind cultural sensitivity and local norms based on their previous experience and knowledge. 6. SOP for saliva cotinine assessment: with the help of York University, the NIMHANS is using state of the art technology to assess saliva cotinine. They have developed SOP for this purpose and are currently standardising the procedure. The collaboration is multi-disciplinary: The University of Liverpool: Psychiatry, theory based Behavioural techniques, public health, epidemiology and clinical trial expertise The University of York: Behavioural Techniques for cigarette smoking reduction/quitting, qualitative research, public health, health economics NIMHANS: Psychiatry, psychology, public health, field epidemiology ARK foundation: Health economics, public health, field epidemiology LSTM: Clinical Trial; statistics RTI, International: Environmental exposure assessment The Healis-Sekhsaria Institute: Health policy IIIT - Delhi: IT related activities including setting up electronic database, and 'voice messaging', one of the key component of intervention package.
Start Year 2015
 
Description IMPRESS collaboration 
Organisation Research Triangle Institute International
Country United States 
Sector Charity/Non Profit 
PI Contribution Our UK team is working in collaboration with the local teams in India and Bangladesh, where field work is being carried out. We have identified the research area and developed the key research questions. We helped local teams in developing the research grant application and Identify appropriate local partners. So far our team and collaborators conducted four workshops, three in Dhaka for i) proposal development ii) analysis of qualitative data and iii) development of intervention, and one in Liverpool to plan the fieldwork. For the last workshop in Dhaka (Feb 2016) our group carried out a systematic review to inform about the intervention used by other researchers to reduce the secondhand smoke exposure to pregnant women. We also shared our knowledge and experience of behavioral change techniques that have been used in our previous similar research projects. We are also helping local teams to develop SOPs for the pilot trial.
Collaborator Contribution York University is helping to carry out qualitative research component to enhance capacity of local teams. In the intervention development workshop they trained local teams analyse in-depth interview data to inform formative research. The York University team also contributed to the other components of research for the development of intervention. The NIMHANS and ARK Foundation teams have brought local knowledge and cultural aspects to modulate intervention in addition to contribute to intervention development based on their previous experience. NIMHANS and ARK foundation also brought local collaborators to finalise the intervention and helped identify study centres for the pilot trial. NIMHANS has a well reputed laboratory to carry out saliva cotinine anlaysis. They have standardised the procedure and developed a SOP for this purpose.
Impact 1. Successful grant application: This collaboration has successfully secured MRC-DBT collaboration funding for next one and half year to develop and pilot an intervention to reduce second-hand smoke (SHS) exposure in pregnant women. 2. Building capacity to analyse qualitative data: In-depth interviews carried out to assess knowledge regarding SHS hazards, and preference of intervention to reduce SHS exposure. In total 67 interviews with pregnant women, husbands and family members who smoke at home and husbands who do not smoke at home or do not smoke at all were carried out. The data was analysed using Nvivo software. The University of York led capacity building exercise helped local teams understand the analysis methodology and use software. Currently both teams are analysing data independently with regular input from the York team. 3. Systematic review: A systematic Review was carried out to assess type of interventions used in similar situations in which pregnant women were the agents of change to reduce their exposure to secondhand smoke. 4. Expert opinion: Experts in the area of smoking cessation related field were contacted and asked to provide rating for the selected behavioural change techniques using a modified Delphi technique. 5. Finalsation of intervention: During last workshop of researchers, using detailed deliberation and consensus development, finalised interventions based on qualitative data, systematic review and expert opinion. The local teams have developed first draft of the intervention keeping in mind cultural sensitivity and local norms based on their previous experience and knowledge. 6. SOP for saliva cotinine assessment: with the help of York University, the NIMHANS is using state of the art technology to assess saliva cotinine. They have developed SOP for this purpose and are currently standardising the procedure. The collaboration is multi-disciplinary: The University of Liverpool: Psychiatry, theory based Behavioural techniques, public health, epidemiology and clinical trial expertise The University of York: Behavioural Techniques for cigarette smoking reduction/quitting, qualitative research, public health, health economics NIMHANS: Psychiatry, psychology, public health, field epidemiology ARK foundation: Health economics, public health, field epidemiology LSTM: Clinical Trial; statistics RTI, International: Environmental exposure assessment The Healis-Sekhsaria Institute: Health policy IIIT - Delhi: IT related activities including setting up electronic database, and 'voice messaging', one of the key component of intervention package.
Start Year 2015
 
Description IMPRESS collaboration 
Organisation University of York
Country United Kingdom 
Sector Academic/University 
PI Contribution Our UK team is working in collaboration with the local teams in India and Bangladesh, where field work is being carried out. We have identified the research area and developed the key research questions. We helped local teams in developing the research grant application and Identify appropriate local partners. So far our team and collaborators conducted four workshops, three in Dhaka for i) proposal development ii) analysis of qualitative data and iii) development of intervention, and one in Liverpool to plan the fieldwork. For the last workshop in Dhaka (Feb 2016) our group carried out a systematic review to inform about the intervention used by other researchers to reduce the secondhand smoke exposure to pregnant women. We also shared our knowledge and experience of behavioral change techniques that have been used in our previous similar research projects. We are also helping local teams to develop SOPs for the pilot trial.
Collaborator Contribution York University is helping to carry out qualitative research component to enhance capacity of local teams. In the intervention development workshop they trained local teams analyse in-depth interview data to inform formative research. The York University team also contributed to the other components of research for the development of intervention. The NIMHANS and ARK Foundation teams have brought local knowledge and cultural aspects to modulate intervention in addition to contribute to intervention development based on their previous experience. NIMHANS and ARK foundation also brought local collaborators to finalise the intervention and helped identify study centres for the pilot trial. NIMHANS has a well reputed laboratory to carry out saliva cotinine anlaysis. They have standardised the procedure and developed a SOP for this purpose.
Impact 1. Successful grant application: This collaboration has successfully secured MRC-DBT collaboration funding for next one and half year to develop and pilot an intervention to reduce second-hand smoke (SHS) exposure in pregnant women. 2. Building capacity to analyse qualitative data: In-depth interviews carried out to assess knowledge regarding SHS hazards, and preference of intervention to reduce SHS exposure. In total 67 interviews with pregnant women, husbands and family members who smoke at home and husbands who do not smoke at home or do not smoke at all were carried out. The data was analysed using Nvivo software. The University of York led capacity building exercise helped local teams understand the analysis methodology and use software. Currently both teams are analysing data independently with regular input from the York team. 3. Systematic review: A systematic Review was carried out to assess type of interventions used in similar situations in which pregnant women were the agents of change to reduce their exposure to secondhand smoke. 4. Expert opinion: Experts in the area of smoking cessation related field were contacted and asked to provide rating for the selected behavioural change techniques using a modified Delphi technique. 5. Finalsation of intervention: During last workshop of researchers, using detailed deliberation and consensus development, finalised interventions based on qualitative data, systematic review and expert opinion. The local teams have developed first draft of the intervention keeping in mind cultural sensitivity and local norms based on their previous experience and knowledge. 6. SOP for saliva cotinine assessment: with the help of York University, the NIMHANS is using state of the art technology to assess saliva cotinine. They have developed SOP for this purpose and are currently standardising the procedure. The collaboration is multi-disciplinary: The University of Liverpool: Psychiatry, theory based Behavioural techniques, public health, epidemiology and clinical trial expertise The University of York: Behavioural Techniques for cigarette smoking reduction/quitting, qualitative research, public health, health economics NIMHANS: Psychiatry, psychology, public health, field epidemiology ARK foundation: Health economics, public health, field epidemiology LSTM: Clinical Trial; statistics RTI, International: Environmental exposure assessment The Healis-Sekhsaria Institute: Health policy IIIT - Delhi: IT related activities including setting up electronic database, and 'voice messaging', one of the key component of intervention package.
Start Year 2015
 
Title The picture booklet 
Description The picture booklet consists of a combination of graphics and text description on topics relevant to reduction of SHS at home. These include but are not limited to i) knowledge about SHS, ii) benefits of change, iii) taking practical steps to reduce smoking at home, iv) getting the help of family members etc. It also included a page in the end where the pregnant woman and her spouse discuss and put down three commitments they make towards a smoke free home. The picture booklet also includes the cotinine feedback report and letter from the future child described below. The picture booklet was developed in English and translated to Kannada and Bengali for use in the pilot RCT in India and Bangladesh. The booklet is being tested in a pilot study in India and Bangladesh. Both the MRC and DBT, India are the principle funding bodies for the intervention. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Initial development
Year Development Stage Completed 2016
Development Status Under active development/distribution
Impact The pilot study suggests the intervention is feasible and acceptable to the study population. The preliminary findings from one site show change in husbands' behaviour to reduce smoking inside homes. Further analysis is underway. 
 
Description 47th Union World Conference on Lung Health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A symposium on 'second-hand smoking' was organised in the conference and results of the qualitative component of the study along with systematic review were presented. This symposium led to question and answer session at the end. Other researchers attending the conference showed keen interest in the study and asked a number of questions including the study methodology and the intervention development process.
Year(s) Of Engagement Activity 2016
 
Description Conference presentation (ePoster) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact World Conference on Tobacco or Health 2018 in South Africa.
Year(s) Of Engagement Activity 2017
 
Description Dhaka Tobacco control meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Official from Tobacco Control Ministry was invited to apprise him of the project and its intended aims. He was informed about the magnitude of the problem related to secondhand smoke exposure in pregnant women. The official assured us of his support for the project. At the end of the project results will be presented to the Tobacco control ministry to inform policy.
Year(s) Of Engagement Activity 2015
 
Description Global Research Programme in Women and Child Health Workshop 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The UK-India Joint Global Research Programme on Women's and children's health is a partnership between the UK's Medical Research Council (MRC) and the Department of Biotechnology (DBT) in India working in collaboration with the Department of International Development (DFID). The programme brings together researchers from UK, India and low income countries to address major health needs of women and children in low resource settings. Seven, three year research projects have been funded under this collaborative scheme, with a joint investment of £6 million.

In this regard, an event "Global Research Programme in Women and Child Health Workshop" is scheduled on October 17th, 2016. The purpose of this event is to bring together researchers funded under the UK-India global research programme in women and child health to present and discuss their ongoing research in this field with key stakeholders, practitioners and policy makers in India, as well as lay the foundations for further investment into this important topic area.
Year(s) Of Engagement Activity 2016
 
Description MARCE international conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The MARCE Society for Perinatal Mental Health has its annual conferences regularly. The 2016 conference was in Melbourne. More than 400 delegates participated in the deliberations. The delegates included mostly working professional in the area of maternal and child mental health. Other stakeholders such as NGO representatives, social activists and the media were also there. This is the most sought after conference in the area of perinatal mental health and the poster received good visibility and dissemination and also won the best poster prize.
Year(s) Of Engagement Activity 2016
 
Description Steering group workshop 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Steering group members including PI and co-IS held a workshop to assess the study progress and discuss study findings from data collected in Bangladesh. Overall, the team was satisfied with the way pilot study was carried out. Development of the intervention and pilot were executed well by team in Dhaka. The recruitment rates of pilot study, acceptability of the intervention, data management, intervention delivery and all other components were delivered in timely fashion.

Also, the group evaluated the progress of the study components carried out in India. The group was satisfied with the progress of the study and it will be completed within the timescale.

The team finalised analysis, publication and dissemination plans. They also agreed to apply for further funding based on this study findings in Spring 2018.
Year(s) Of Engagement Activity 2017