Table 1 TB & Tobacco intervention components and messages

Flipbook: for use during consultations with all TB patients following diagnosis and at any point during the 6 months of TB treatment to reinforce messages and support quit attempts

Eight pages with photo pages facing patients and text facing health professionals. One version with photos targeting male patients and one version with photos targeting female patients: the first 5 pages include key messages on TB management, and the final 3 pages have messages regarding tobacco (cigarettes and smokeless)

TB messages:

(i) It is very likely that your TB will be cured if you take your medicines as instructed

(ii) Keep taking medicines regularly

(iii) Come for scheduled appointments, your health worker is here to support you

(iv) Understanding how TB spreads

(v) Importance of social support

(vi) Adopt a healthy diet and lifestyle, including quitting tobacco

Cessation messages:

(i) Abrupt cessation: set a quit date and then, “not a puff”

(ii) How to deal with side effects

(iii) Identifying triggers and alternative strategies

(iv) Consequences of tobacco use (cigarettes and smokeless) on TB, long-term health and finances

(v) Dangers of second-hand smoke

Behaviour change techniques:

(i) Goal-setting (1.1)

(ii) Reducing negative emotions (1.2)

(iii) Action-planning (1.4)

(iv) Prompting social support (3.1, 3.2, 3.3)

(v) Instructions on performing behaviours (4.1)

(vi) Information on health and emotional consequences (5.1, 5.6)

(vii) Habit formation (8.3)

(viii) Comparative imagining of future outcomes (9.3)

(ix) Reducing negative emotions (11.2)

(x) Reducing exposure to cues for behaviour (12.3)

(xi) Building rapport, being an active listener

Leaflet: for TB patients, their carers and family members

Using photos and illustrations and simple text highlighting the consequences of tobacco use (cigarettes and smokeless), link with TB, benefits of quitting and how to deal with side effects of quitting

Two posters: for use within TB clinic waiting areas

One presenting health benefits of quitting (general, not TB-specific) and one advertising the cessation service

A health worker guide: to be used in conjunction with the flipbook, leaflet and posters

Providing the evidence behind the key messages, tips for adaptation and strategies for building rapport and good communication with both male and female patients

Further adaptations made based on TB & Tobacco trial process evaluation

Desk reminder: one page, laminated to be stuck on or beside the TB health worker’s desk

Reiterating key messages and including details of the TB & Tobacco website where all materials are available for further reference

Training of trainers (ToT): Half-day programme

Introducing the intervention, key messages and underlying evidence. How to deliver the messages and support TB health workers to deliver

Includes a country-specific 10-minute video modelling how to ask about tobacco use, advise and support patients to quit

Training session: 2-hour training session for TB health workers delivered by trainers following the ToT above

Introducing the intervention and key cessation messages, and how to complete the tobacco columns in the recording forms. Including the 10-minute video above

By delivering these key messages using simple BCTs, TB health workers help their patients to quit as part of routine care

Awareness-raising video: for TB programme managers and policy-makers

Three-minute video explaining the link between TB and tobacco and the need to include tobacco cessation support for TB patients

Inclusion of tobacco cessation within the TB programme is feasible and can improve TB outcomes