Abstract
Abstract
Background
Tobacco use remains one of the leading preventable causes of morbidity and mortality worldwide. In Pakistan, limited access to evidence-based smoking-cessation services highlights the need for innovative community-based approaches. Tobacco retailers and community-based organisation (CBO) workers interact regularly with smokers and may represent an underutilised resource for delivering smoking-cessation information. This study assessed pre- to post-training changes in knowledge and perceptions among tobacco retailers and CBO workers in Pakistan.
Methods
A multi-centre, one-group paired pre–post quasi-experimental study was conducted in Abbottabad, Karachi, Lahore, Peshawar, Islamabad and Rawalpindi, Pakistan. A total of 279 participants (139 tobacco retailers and 140 CBO workers) completed questionnaires immediately before and after training. Paired binary outcomes were analysed using two-sided exact McNemar tests. Follow-up data were obtained from 113 participants (56 retailers and 57 CBO workers) approximately three months after training.
Results
All 139 tobacco retailers and 140 CBO workers were matched between pre- and post-training questionnaires. Awareness of modern smoking-cessation methods increased from 30.2% to 95.0% among retailers and from 18.6% to 96.4% among CBO workers (both exact McNemar p < 0.001). Correct recognition that nicotine was not the direct cause of the diseases listed in the questionnaire increased from 16.5% to 79.1% among retailers (n = 139) and from 8.8% to 72.3% among CBO workers (n = 137; both p < 0.001). At follow-up, 53/56 retailers (94.6%) and 55/57 CBO workers (96.5%) reported discussing quitting with smokers; these outcomes were self-reported and were not independently verified.
Conclusions
The training was associated with improvements in smoking-cessation knowledge and perceptions among tobacco retailers and CBO workers. Training community-facing groups may be a feasible way to complement smoking-cessation education in resource-constrained settings. Controlled studies are required to assess knowledge retention, behavioural outcomes, and any effect on smoking cessation.