title: Barriers and facilitators to expanding the role of community health workers to include smoking cessation services in Vietnam: a qualitative analysis.
abstract: BACKGROUND
  Despite high smoking rates, cessation services are largely unavailable in Vietnam. This study explored attitudes and beliefs of community health workers (CHWs) towards expanding their role to include delivering tobacco use treatment (TUT), and potential barriers and facilitators associated with implementing a strategy in which health centers would refer patients to CHWs for cessation services.
  
  
  METHODS
  We conducted four focus groups with 29 CHWs recruited from four district community health centers (CHCs) in Hanoi, Vietnam.
  
  
  RESULTS
  Participants supported expanding their role saying that it fit well with their current responsibilities. They further endorsed the feasibility of serving as a referral resource for providers in local CHCs expressing the belief that CHWs were "more suitable than their clinical colleagues" to offer cessation assistance. The most frequently cited barrier to routinely offering cessation services was that despite enacting a National Tobacco Control Action plan, cessation is not one of the national prevention priorities. As a result, CHWs have not been "assigned" to help smokers quit by the Ministry of Health. Additional barriers included lack of training and time constraints.
  
  
  CONCLUSIONS
  Focus groups suggest that implementing a systems-level intervention that allows providers to refer smokers to CHWs is a promising model for extending the treatment of tobacco use beyond primary care settings and increasing access to smoking cessation services in Vietnam. There is a need to test the cost-effectiveness of this and other strategies for implementing TUT guidelines to support and inform national tobacco control policies in Vietnam and other low-and middle-income countries.
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York 10016, NY, USA. donna.shelley@nyumc.org.
authors.forename: Donna
authors.initials: D
authors.lastname: Shelley
authors.forename: Linh
authors.initials: L
authors.lastname: Nguyen
authors.forename: Hieu
authors.initials: H
authors.lastname: Pham
authors.forename: Nancy
authors.initials: N
authors.lastname: VanDevanter
authors.forename: Nam
authors.initials: N
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D003150:Community Health Workers; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D024382:Professional Role; D036301:Qualitative Research; D016540:Smoking Cessation; D016896:Treatment Outcome; D014744:Vietnam