Upscaling a behavioural intervention program for tobacco use cessation – A randomised controlled study

A randomised control trial was conducted among school teachers in Bihar, India for upscaling a tested, evidence-based tobacco intervention using train-the-trainer model. Six blocks in three districts were selected and randomised into intervention and control blocks. Cluster coordinators in intervention blocks were given training in the details of intervention. Cluster coordinators routinely train headmasters and they were asked to include intervention training in their routine. Except for the training material, no additional resources were provided to cluster coordinators and headmasters. Headmasters implemented the intervention along with the teachers in the school. Post-intervention random sample of 70 schools out of 219 schools from intervention blocks and 70 schools out of 224 schools in control blocks were surveyed. The survey was self-administered among 429 school teachers in intervention schools and 331 among control schools. For all 140 headmasters, the survey was interviewer administered. Almost all headmasters in intervention schools had attended the training and had involved teachers in the intervention program. Odds ratios for carrying out the recommended activities in intervention schools compared to control schools were very high and significant. In addition, intervention schools also conducted activities such as including intervention messages in classroom teaching and conveying them to parents, activities that were not directly recommended in intervention program. Thus, this train-the-trainer model demonstrated that it is possible to upscale the intervention programs successfully with the resources within the system.