Usability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and Zambia
Abstract Background Text messaging-based interventions (TMIs) have demonstrated effectiveness in reducing tobacco use in many populations. However, such interventions have not been tailored to meet the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan...
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BMC
2025-07-01
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| Series: | Addiction Science & Clinical Practice |
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| Online Access: | https://doi.org/10.1186/s13722-025-00580-z |
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| author | Heather Wipfli Jim Arinaitwe Fastone Goma Lynn Atuyambe David Guwatudde Masauso Moses Phiri Elizeus Rutebemberwa Fred Wabwire-Mangen Richard Zulu Cosmas Zyambo Kyra Guy Ronald Kusolo Musawa Mukupa Ezekiel Musasizi Joan S. Tucker |
| author_facet | Heather Wipfli Jim Arinaitwe Fastone Goma Lynn Atuyambe David Guwatudde Masauso Moses Phiri Elizeus Rutebemberwa Fred Wabwire-Mangen Richard Zulu Cosmas Zyambo Kyra Guy Ronald Kusolo Musawa Mukupa Ezekiel Musasizi Joan S. Tucker |
| author_sort | Heather Wipfli |
| collection | DOAJ |
| description | Abstract Background Text messaging-based interventions (TMIs) have demonstrated effectiveness in reducing tobacco use in many populations. However, such interventions have not been tailored to meet the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). We describe the process of adapting the SmokefreeTXT message library so that it is applicable to all forms of tobacco use, addresses issues specifically facing PLWH who use tobacco, and is culturally appropriate for use in Uganda and Zambia. Methods/design Participants were PLWH who currently used tobacco and health services workers recruited from HIV clinics in two regions of Uganda and two regions of Zambia. Eight focus groups (N = 48) were conducted with PLWH tobacco users and four focus groups (N = 28) were conducted with healthcare providers to adapt the TMI content for the cultural context and HIV status. A subsample of PLWH focus group participants (N = 14) provided feedback on the adapted TMI after using it for three weeks on their own phone. Focus group transcripts were analyzed for key themes based on the moderator guides using Dedoose software™. Means and percentages were calculated for survey data to assess the TMI’s acceptability and feasibility. Results Focus group feedback on facilitators and barriers to quitting tobacco, as well as strengths and limitations of the TMI-based intervention approach, were used to finalize the adapted TMI’s content and delivery for usability testing. PLWH identified multiple barriers to quitting tobacco including addiction, lack of support and education, and community perceptions. Health service workers highlighted the need for community-level interventions, improved provider knowledge on tobacco cessation, and tailored support strategies. Usability testing participants rated the TMI as helpful and relevant, emphasizing the interactive features as supportive and beneficial. Further, they reported few problems using it over three weeks, except for difficulty keeping their phone charged. Conclusions Results suggest that an adapted version of SmokefreeTXT is a feasible and acceptable option for PLWH in Uganda and Zambia who are interested in quitting tobacco use. Trial registration: ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807 |
| format | Article |
| id | doaj-art-b36f57c4f55b49b2ae4702230d544fd4 |
| institution | Kabale University |
| issn | 1940-0640 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj-art-b36f57c4f55b49b2ae4702230d544fd42025-08-20T03:46:25ZengBMCAddiction Science & Clinical Practice1940-06402025-07-0120112210.1186/s13722-025-00580-zUsability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and ZambiaHeather Wipfli0Jim Arinaitwe1Fastone Goma2Lynn Atuyambe3David Guwatudde4Masauso Moses Phiri5Elizeus Rutebemberwa6Fred Wabwire-Mangen7Richard Zulu8Cosmas Zyambo9Kyra Guy10Ronald Kusolo11Musawa Mukupa12Ezekiel Musasizi13Joan S. Tucker14Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern CaliforniaSchool of Public Health, Centre for Tobacco Control in Africa, Makerere UniversitySchool of Medicine, Centre For Primary Care Research, University of ZambiaDepartment of Community Health and Behavioural Sciences, School of Public Health, Makerere UniversityDepartment of Epidemiology and Biostatistics, Makerere University School of Public HealthSchool of Medicine, Centre For Primary Care Research, University of ZambiaDepartment of Health Policy, Planning, and Management, School of Public Health, Makerere UniversityDepartment of Epidemiology and Biostatistics, Makerere University School of Public HealthSchool of Medicine, Centre For Primary Care Research, University of ZambiaDepartment of Community and Family Medicine, School of Public Health, University of ZambiaDepartment of Population and Public Health Sciences, Keck School of Medicine, University of Southern CaliforniaSchool of Public Health, Centre for Tobacco Control in Africa, Makerere UniversitySchool of Medicine, Centre For Primary Care Research, University of ZambiaSchool of Public Health, Centre for Tobacco Control in Africa, Makerere UniversityRAND CorporationAbstract Background Text messaging-based interventions (TMIs) have demonstrated effectiveness in reducing tobacco use in many populations. However, such interventions have not been tailored to meet the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). We describe the process of adapting the SmokefreeTXT message library so that it is applicable to all forms of tobacco use, addresses issues specifically facing PLWH who use tobacco, and is culturally appropriate for use in Uganda and Zambia. Methods/design Participants were PLWH who currently used tobacco and health services workers recruited from HIV clinics in two regions of Uganda and two regions of Zambia. Eight focus groups (N = 48) were conducted with PLWH tobacco users and four focus groups (N = 28) were conducted with healthcare providers to adapt the TMI content for the cultural context and HIV status. A subsample of PLWH focus group participants (N = 14) provided feedback on the adapted TMI after using it for three weeks on their own phone. Focus group transcripts were analyzed for key themes based on the moderator guides using Dedoose software™. Means and percentages were calculated for survey data to assess the TMI’s acceptability and feasibility. Results Focus group feedback on facilitators and barriers to quitting tobacco, as well as strengths and limitations of the TMI-based intervention approach, were used to finalize the adapted TMI’s content and delivery for usability testing. PLWH identified multiple barriers to quitting tobacco including addiction, lack of support and education, and community perceptions. Health service workers highlighted the need for community-level interventions, improved provider knowledge on tobacco cessation, and tailored support strategies. Usability testing participants rated the TMI as helpful and relevant, emphasizing the interactive features as supportive and beneficial. Further, they reported few problems using it over three weeks, except for difficulty keeping their phone charged. Conclusions Results suggest that an adapted version of SmokefreeTXT is a feasible and acceptable option for PLWH in Uganda and Zambia who are interested in quitting tobacco use. Trial registration: ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807https://doi.org/10.1186/s13722-025-00580-zTobaccoCessationHIVText messagingInterventionSub-Saharan Africa |
| spellingShingle | Heather Wipfli Jim Arinaitwe Fastone Goma Lynn Atuyambe David Guwatudde Masauso Moses Phiri Elizeus Rutebemberwa Fred Wabwire-Mangen Richard Zulu Cosmas Zyambo Kyra Guy Ronald Kusolo Musawa Mukupa Ezekiel Musasizi Joan S. Tucker Usability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and Zambia Addiction Science & Clinical Practice Tobacco Cessation HIV Text messaging Intervention Sub-Saharan Africa |
| title | Usability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and Zambia |
| title_full | Usability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and Zambia |
| title_fullStr | Usability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and Zambia |
| title_full_unstemmed | Usability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and Zambia |
| title_short | Usability and cultural adaptation of a text message-based tobacco cessation intervention for people living with HIV in Uganda and Zambia |
| title_sort | usability and cultural adaptation of a text message based tobacco cessation intervention for people living with hiv in uganda and zambia |
| topic | Tobacco Cessation HIV Text messaging Intervention Sub-Saharan Africa |
| url | https://doi.org/10.1186/s13722-025-00580-z |
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