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How do tobacco control policies work in low-income and middle-income countries? A realist synthesis

BACKGROUND: The burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, di...

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Autores principales: Hebbar, Pragati Bhaskar, Dsouza, Vivek, Bhojani, Upendra, Prashanth, Nuggehalli Srinivas, van Schayck, Onno CP, Babu, Giridhara R, Nagelhout, Gera E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644319/
https://www.ncbi.nlm.nih.gov/pubmed/36351683
http://dx.doi.org/10.1136/bmjgh-2022-008859
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author Hebbar, Pragati Bhaskar
Dsouza, Vivek
Bhojani, Upendra
Prashanth, Nuggehalli Srinivas
van Schayck, Onno CP
Babu, Giridhara R
Nagelhout, Gera E
author_facet Hebbar, Pragati Bhaskar
Dsouza, Vivek
Bhojani, Upendra
Prashanth, Nuggehalli Srinivas
van Schayck, Onno CP
Babu, Giridhara R
Nagelhout, Gera E
author_sort Hebbar, Pragati Bhaskar
collection PubMed
description BACKGROUND: The burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, diversity in outcomes of widely implemented policies and the defining role of the context, we conducted a realist synthesis to examine tobacco control policy implementation in LMICs. METHODS: We conducted a systematic realist literature review to test an initial programme theory developed by the research team. We searched EBSCOHost and Web of Science, containing 19 databases. We included studies on implementation of government tobacco control policies in LMICs. RESULTS: We included 47 studies that described several contextual factors, mechanisms and outcomes related to implementing tobacco control policies to varying depth. Our initial programme theory identified three overarching strategies: awareness, enforcement, and review systems involved in implementation. The refined programme theory identifies the plausible mechanisms through which these strategies could work. We found 30 mechanisms that could lead to varying implementation outcomes including normalisation of smoking in public places, stigmatisation of the smoker, citizen participation in the programme, fear of public opposition, feeling of kinship among violators and the rest of the community, empowerment of authorised officials, friction among different agencies, group identity among staff, shared learning, manipulation, intimidation and feeling left out in the policy-making process. CONCLUSIONS: The synthesis provides an overview of the interplay of several contextual factors and mechanisms leading to varied implementation outcomes in LMICs. Decision-makers and other actors may benefit from examining the role of one or more of these mechanisms in their particular contexts to improve programme implementation. Further research into specific tobacco control policies and testing particular mechanisms will help deepen our understanding of tobacco control implementation in LMICs. PROSPERO REGISTRATION NUMBER: CRD42020191541.
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spelling pubmed-96443192022-11-15 How do tobacco control policies work in low-income and middle-income countries? A realist synthesis Hebbar, Pragati Bhaskar Dsouza, Vivek Bhojani, Upendra Prashanth, Nuggehalli Srinivas van Schayck, Onno CP Babu, Giridhara R Nagelhout, Gera E BMJ Glob Health Original Research BACKGROUND: The burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, diversity in outcomes of widely implemented policies and the defining role of the context, we conducted a realist synthesis to examine tobacco control policy implementation in LMICs. METHODS: We conducted a systematic realist literature review to test an initial programme theory developed by the research team. We searched EBSCOHost and Web of Science, containing 19 databases. We included studies on implementation of government tobacco control policies in LMICs. RESULTS: We included 47 studies that described several contextual factors, mechanisms and outcomes related to implementing tobacco control policies to varying depth. Our initial programme theory identified three overarching strategies: awareness, enforcement, and review systems involved in implementation. The refined programme theory identifies the plausible mechanisms through which these strategies could work. We found 30 mechanisms that could lead to varying implementation outcomes including normalisation of smoking in public places, stigmatisation of the smoker, citizen participation in the programme, fear of public opposition, feeling of kinship among violators and the rest of the community, empowerment of authorised officials, friction among different agencies, group identity among staff, shared learning, manipulation, intimidation and feeling left out in the policy-making process. CONCLUSIONS: The synthesis provides an overview of the interplay of several contextual factors and mechanisms leading to varied implementation outcomes in LMICs. Decision-makers and other actors may benefit from examining the role of one or more of these mechanisms in their particular contexts to improve programme implementation. Further research into specific tobacco control policies and testing particular mechanisms will help deepen our understanding of tobacco control implementation in LMICs. PROSPERO REGISTRATION NUMBER: CRD42020191541. BMJ Publishing Group 2022-11-08 /pmc/articles/PMC9644319/ /pubmed/36351683 http://dx.doi.org/10.1136/bmjgh-2022-008859 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Hebbar, Pragati Bhaskar
Dsouza, Vivek
Bhojani, Upendra
Prashanth, Nuggehalli Srinivas
van Schayck, Onno CP
Babu, Giridhara R
Nagelhout, Gera E
How do tobacco control policies work in low-income and middle-income countries? A realist synthesis
title How do tobacco control policies work in low-income and middle-income countries? A realist synthesis
title_full How do tobacco control policies work in low-income and middle-income countries? A realist synthesis
title_fullStr How do tobacco control policies work in low-income and middle-income countries? A realist synthesis
title_full_unstemmed How do tobacco control policies work in low-income and middle-income countries? A realist synthesis
title_short How do tobacco control policies work in low-income and middle-income countries? A realist synthesis
title_sort how do tobacco control policies work in low-income and middle-income countries? a realist synthesis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644319/
https://www.ncbi.nlm.nih.gov/pubmed/36351683
http://dx.doi.org/10.1136/bmjgh-2022-008859
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