Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II) study protocol for a cluster randomised controlled trial of a community based smoke-free homes intervention, with or without Indoor Air Quality feedback

Background: Second-hand smoke (SHS) is a serious health hazard costing 890,000 lives a year globally. Women
and children in many economically developing countries are worst affected as smoke-free laws are only partially
implemented and homes remain a major source of SHS exposure. There is limited evidence on interventions
designed to reduce SHS exposure in homes, especially in community settings. Following a successful pilot, a
community-based approach to promote smoke-free homes in Bangladesh, a country with a strong commitment
to smoke-free environments but with high levels of SHS exposure, will be evaluated. The study aims to assess the
effectiveness and cost-effectiveness of a community-based intervention, Muslims for better Health (M4bH), with or
without Indoor Air Quality (IAQ) feedback, in reducing non-smokers’ exposure to SHS in the home.
Methods/design: Based on behaviour-change theories, M4bH and IAQ feedback are designed to discourage
people from smoking indoors. M4bH consists of a set of messages couched within mainstream Islamic discourse,
delivered weekly by faith leaders (imams and khatibs) in mosques over 12 weeks (one message each week). The
messages address key determinants of current smoking behaviours including lack of knowledge and misconceptions
on specific harms associated with SHS exposure. IAQ feedback consists of personalised information on IAQ measured
by a particulate matter (PM2.5) monitor within the home. Following adaptation of M4bH and IAQ feedback for the
Bangladeshi context, a three-arm cluster randomised controlled trial will be conducted in Dhaka. Forty-five mosques
and 1800 households, with at least one smoker and one non-smoker, will be recruited. Mosques will be randomised
to: M4bH and IAQ feedback; M4bH alone; or usual services only. The primary outcome is 24-h mean household
concentration of indoor fine particulate matter (PM2.5) at 12 months post randomisation. Secondary outcomes are
24-h mean household PM2.5 at 3 months post randomisation, frequency and severity of respiratory symptoms,
health care service use and quality of life. A cost-effectiveness analysis and process evaluation will also be conducted.

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