title: Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system.
abstract: Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC.
  
  
  
  We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study.
  
  
  
  The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting).
  
  
  
  In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC.
  
  
  
  NCT02564653 . Registered September 2015.
authors.affiliation: Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA. nvd2@nyu.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: VanDevanter
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th St, New York, NY, 10016, USA.
authors.forename: Pritika
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Institute of Social Medical Studies, The Institute of Social and Medical Studies, No 18 Lot 12B, Trung Yen 10 Street, Trung Hoa Ward, Cau Giay District, Ha Noi, Vietnam.
authors.forename: Nam
authors.initials: N
authors.lastname: Nguyen
authors.affiliation: Institute of Social Medical Studies, The Institute of Social and Medical Studies, No 18 Lot 12B, Trung Yen 10 Street, Trung Hoa Ward, Cau Giay District, Ha Noi, Vietnam.
authors.forename: Linh
authors.initials: L
authors.lastname: Nguyen
authors.affiliation: Institute of Social Medical Studies, The Institute of Social and Medical Studies, No 18 Lot 12B, Trung Yen 10 Street, Trung Hoa Ward, Cau Giay District, Ha Noi, Vietnam.
authors.forename: Trang
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Johns Hopkins School of Public Health, 2213 McElderry Street, 4th floor, Baltimore, Maryland, 21205, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: Stillman
authors.affiliation: Department of Global Health, University of Washington, Harris Hydraulics Laboratory, Box 357965, Seattle, WA, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Weiner
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th St, New York, NY, 10016, USA.
authors.forename: Donna
authors.identifier: 0000-0003-1677-2577
authors.initials: D
authors.lastname: Shelley
mesh_terms: D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000379:methods*; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D017410:Practice Guidelines as Topic; D011634:Public Health / Q000379:methods*; D036301:Qualitative Research; D064424:Tobacco Use / Q000628:therapy*; D020340:Tobacco Use Cessation / Q000379:methods*; D014744:Vietnam
keywords: CFIR; Qualitative methods; Smoking cessation; Tobacco use; Vietnam