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Health Educ Res. 2018 Jun 1;33(3):218-231. doi: 10.1093/her/cyy011.

Scaling up a tobacco control intervention in low resource settings: a case example for school teachers in India.

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Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, Maharashtra, India.
Department of Social and Behavioral Sciences, Harvard School of Public Health, Center for Community-Based Research, Dana Farber Cancer Institute, Boston, MA 02115, USA.
Biostatistical Consultant, Pelham, MA 01002, USA.


Research on processes of bringing effective tobacco control interventions to scale to increase quit rates among tobacco users is uncommon. This study examines processes to bring to scale one such intervention for school teachers, i.e. Tobacco Free Teacher-Tobacco Free Society (TFT-TFS). This intervention provides a foundation for an effective and low cost approach to promote cessation through schools. The present study was conducted in the states of Bihar and Maharashtra in 2014 using quantitative and qualitative methods. Focus group discussions (FGDs) were analysed using immersion crystallization method. The data presented are from a survey of 291 principals and seven FGDs. This study examined characteristics of principals and teachers, organizational environment, external environmental factors and program characteristics to determine facilitators and barriers for successful dissemination and implementation of the TFT-TFS program. Some facilitators were, incorporation of the program in existing channels like staff meetings and trainings, certification and recognition by the department of education; while some barriers were routine time bound duties (mainly teaching) of teachers and prevalence of tobacco use among teachers and administrators. Principals and teachers expressed a need and high level of interest in the adoption and implementation of the TFT-TFS program in their schools.

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