Objectives Smoking cessation interventions developed in Western countries have not been as effective in helping people quit smoking when implemented outside of the Western context. This may be because smoking behaviours and predictors are rooted in culture. We define culture as the collective or shared values and beliefs that guide peoples’ decisions and behaviours. Adapting effective cessation interventions to address culturally influenced predictors of smoking behaviours could improve their impact across communities. However, the evidence of the overall effectiveness of culturally tailored interventions remains unclear, as well as the relative effectiveness of different tailoring methods. Interventions that are tailored more deeply, for example incorporating messaging drawn from cultural values may have more impact than those tailored more superficially (language translation). The aim of this systematic review is to examine the impact of culturally tailoring smoking cessation interventions to determine if they are more effective in helping people quit or reduce smoking.
Method We searched Medline, Embase, PsychINFO, and CENTRAL for randomized controlled trials comparing a culturally tailored smoking cessation intervention to an intensity-matched non-tailored intervention or the same intervention without the tailored component. Studies that recruited adults and included quitting and/or reduced smoking as an outcome were included.
Eligibility screening and data extraction will be done in duplicate. We will assess studies for clinical and methodological variance and group them into appropriate comparisons where possible. Dichotomous outcomes relative risks (RR) will be pooled using random-effects Mantel Haenszel methods to calculate pooled RRs and 95% confidence intervals (CI). For smoking reduction as a continuous outcome, mean differences (MD) will be combined using random-effects inverse variance methods to calculate pooled MDs and 95% CI. Subgroup analysis will examine the type and depth of cultural tailoring. We will assess risk of bias using Cochrane’s RoB1 tool and certainty in the evidence using GRADE.
Results We initially found a total of 5,353 titles and after removing duplicates, have screened 3,532 titles and abstracts. A total of 264 titles were moved to the full-text screening stage. We will extract study characteristics and outcome data on cessation or reduction of smoking. We also plan to examine the components of the culturally tailored interventions and classify them according to surface vs. deep tailoring structures. Additional results are forthcoming as this is currently a work in progress.
Conclusions This review aims to gather the evidence currently available on smoking cessation interventions that compare culturally tailored methods to non-tailored or standard interventions. Past reviews on this topic have not yet found any clear evidence that culturally tailoring smoking cessation interventions are more effective. However, these reviews have been limited in scope to specific ethnic groups or regions. Further, there have been additional studies conducted in recent years. This review will also attempt to examine the features of the tailored intervention components and how the depth of tailoring may have an impact on the overall effectiveness of the intervention. Gathering more evidence on the effect of cultural tailoring of smoking cessation interventions is a crucial step in determining what will meet the needs of diverse communities.
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