Muslim Communities Learning About Second-hand Smoke (MCLASS-II) in Bangladesh is an effectiveness-implementation hybrid study funded by Medical Research Council (MRC), UK. This is a three-arm cluster randomised controlled-trial (cRCT) study.
Our overall aim is to reduce the burden of disease due to SHS in LMICs by discovering innovative community-based approaches to behaviour change.
Bangladesh is signatory to the WHO Framework Convention on Tobacco Control (FCTC) which obligates Bangladesh to implement cost-effective policies for tobacco control. Protecting people from second-hand smoke is one of the key six proposed policies of WHO. At the recent launch of Tobacco Control Programme in Bangladesh, exposure to second hand smoke has been identified as a major factor in tobacco related diseases and reducing this exposure is considered as a key policy measure. We envisage that ‘Smoke Free Homes’ (SFH) initiative is likely to provide a ‘quick win’ in this area. Our long term aim is to contribute towards national efforts to reduce non-smoking adult’s exposure to secondhand smoke by carrying out a demonstration project in Bangladesh.
The specific objectives of the study are to (i) explore key family members’ knowledge, attitudes and practices (including positives practices) that promote (or inhibit) SHS exposure at home (ii) identify the modifications required in M4bH and IAQ feedback in order to make it culturally appropriate, feasible, and acceptable for families and imams in Bangladesh; (iii) develop manualised training and delivery procedures for the intervention, and to explore the best format, delivery platform, setting and integration strategies for the components of the intervention aimed at the various target recipients (sequence of delivery; number of sessions and dosage of intervention), and (iv) to assess what competencies and organisational capacity are required for imams and in mosques, respectively, to deliver the intervention.
A qualitative study will be conducted in the residential area of Mirpur. In-depth interviews (IDIs) will be conducted with 30 adults in households (a mix of men who smoke in the home and women whose husbands smoke in the home) from research area, who will be purposively selected to ensure representativeness of age, education, and socio-economic status. Three focus group discussions will be arranged with Imams. The study will involve assessing the acceptance and ideas for modifying Smoke Free Homes (SFH) educational materials and how feasible it is to use these materials. Intervention delivery will also be explored to know the cultural appropriateness with a mainstream Islamic discourse, acceptability and feasibility in the mosque settings. Iterative intervention adaptation workshops will be organised to finalise intervention materials.
The various forms of qualitative data will be collected and organised electronically using qualitative data analysis software such as NVivo. Using a Framework approach, data from these different sources will be organised, coded, and compared thematically and on a case basis. In this way, both a deductive and inductive approach will be taken to analysis of the qualitative data collected.
Confidentiality of the respondents will be ensured for the study. The name of the respondents will not be disclosed in the report. Neither will their designation be used. Consent will be taken before interviewing them. The study will not harm the environment; neither will it involve any test on human beings.
This study will assess the feasibility and acceptability of introducing an intervention using imams as a change agent, thereby help the policy makers to adapt tobacco cessation strategies to the local context. The findings will help the researchers to conduct randomised control trial to assess the effectiveness of the intervention in reducing exposure to second-hand smoke at home.
2. Tobacco Control