Purpose: To synthesize evidence of the effects and potential effect modifiers of different electronic health (eHealth) interventions to help people quit smoking. Methods: Four databases (MEDLINE, PsycINFO, Embase, and The Cochrane Library) were searched in March 2017 using terms that included “smoking cessation”, “eHealth/mHealth” and “electronic technology” to find relevant studies. Meta-analysis and meta-regression analyses were performed using Mantel–Haenszel test for fixed-effect risk ratio (RR) and restricted maximum-likelihood technique, respectively. Protocol Registration Number: CRD42017072560. Results: The review included 108 studies and 110,372 participants. Compared to nonactive control groups (eg, usual care), smoking cessation interventions using web-based and mobile health (mHealth) platform resulted in significantly greater smoking abstinence, RR 2.03 (95% CI 1.7–2.03), and RR 1.71 (95% CI 1.35–2.16), respectively. Similarly, smoking cessation trials using tailored text messages (RR 1.80, 95% CI 1.54–2.10) and web-based information and conjunctive nicotine replacement therapy (RR 1.29, 95% CI 1.17–1.43) may also increase cessation. In contrast, little or no benefit for smoking abstinence was found for computer-assisted interventions (RR 1.31, 95% CI 1.11–1.53). The magnitude of effect sizes from mHealth smoking cessation interventions was likely to be greater if the trial was conducted in the USA or Europe and when the intervention included individually tailored text messages. In contrast, high frequency of texts (daily) was less effective than weekly texts. Conclusions: There was consistent evidence that web-based and mHealth smoking cessation interventions may increase abstinence moderately. Methodologic quality of trials and the intervention characteristics (tailored vs untailored) are critical effect modifiers among eHealth smoking cessation interventions, especially for web-based and text messaging trials. Future smoking cessation intervention should take advantages of web-based and mHealth engagement to improve prolonged abstinence.

Comorbidities are common in respiratory disease patients and have been well-known to impact their quality of life. The objective of this study is to estimate the minimal clinically important difference (MCID) of the health-related quality of life (HRQOL) among respiratory disease patients with different comorbidities in a Vietnamese tertiary hospital. We performed a cross-sectional study from October to November 2016 at the Respiratory Center of Bach Mai Hospital, Hanoi, with a total of 508 participants. Information about socio-economic characteristics, HRQOL and comorbidities of participants was collected. ANOVA was used to identify MCID between patients with and without specific comorbid conditions. Tobit regression was used to explore the associations between comorbidities and the HRQOL. Results showed that the prevalence of cardiovascular comorbidities was 23.8%, followed by musculoskeletal diseases (12.0%), digestive diseases (11.8%), endocrine diseases (10.0%), kidney diseases (5.1%) and ear, nose, and throat diseases (4.5%). Regarding HRQOL, having a problem in pain/discomfort was observed in 61.0% of participants, followed by anxiety/depression (48.2%). Mean EQ-5D index was 0.66 (SD (Standard Deviation) = 0.31). The significant MCID (p < 0.05) was found between patients with and without cardiovascular diseases, musculoskeletal diseases, kidney diseases, and endocrine diseases. The multivariate regression model showed that only musculoskeletal diseases were found to be related with the marked decrement of EQ-5D index score (Coef. = −0.13; 95% CI (Confident Interval) = −0.23; −0.02). Suffering at least one chronic illness was correlated to the marked decrease of EQ-5D index score (Coef. = −0.09; 95% CI = −0.17; −0.01). These results underline the importance of appropriate pain management as well as the provision of an interprofessional care approach to patients in order to alleviate the burden of comorbidities to their treatment outcomes and HRQOL.

Smoking is considered the most critical modifiable factor with regard to lung cancer and remains a public health concern in many countries, including Vietnam, which is among those countries with the highest tobacco consumption rates in the world. This study has examined the impact of national telephone counselling for smoking cessation and has identified the factors associated with the impact of the quitline among male callers in Vietnam. A randomized cross-sectional survey of 469 smokers who sought smoking cessation services via the national quitline was performed from September 2015 to May 2016. The primary outcomes were measured by a self-reported quit rate at the time of assessment, 7 day point prevalence abstinence (PA), 6 month prolonged PA, service satisfaction, and level of motivation. Among the participants, 31.6% were abstinent, and 5.1% of participants successfully stopped smoking and did not need to seek quitline support. Most of the clients were satisfied with the quality of service (88.5%), felt more confident about quitting (74.3%), and took early action via their first quit attempt (81.7%); 18.3% reported a more than 7 day abstinence period at the time of survey. The primary reasons for smoking relapse were surrounding smoking environments (51.6%) and craving symptoms (44.1%). Future smoking cessation efforts should focus on improving the quality of quitline services, client satisfaction, and developing a tailored program and counseling targeting smokers with specific characteristics, especially ones experiencing chronic diseases.

Background: Tobacco kills more than 8 million people each year, mostly in low-and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. Objective: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. Methods: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. Results: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. Conclusions: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low-and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers.

Background/Objectives: Asthma action plans (AAPs) are recommended for patients’ self-management of asthma and should be adapted to a country’s situation. This study aimed to develop expert consensus on the optimal structure, content, and action of asthma action plans for Vietnamese settings to ensure feasibility, acceptance, and implementation. Methods: A Delphi consensus was conducted over two rounds. The proposed items were evaluated by a Vietnamese panel of pulmonologists, allergists, tuberculosis/lung disease specialists, and general practitioners. Structured online questionnaires with five-point Likert scales were used. Consensus was defined as >80% agreement and <10% strong disagreement. Results: A total of 26 and 21 participants completed round 1 and round 2, respectively. The 4-zone format of AAP was preferred (42.3%) over the 3-zone (38.5%) or 2-zone (19.2%) formats. The AAP should include some key statements for asthma, symptoms for self-monitoring, an objective asthma control questionnaire, actions for changes in maintenance medication, and instructions in emergency situations. AAP zones should be classified by symptom frequency and severity. Patient actions should be tailored to their treatment regimen (MART or ICS/LABA + SABA). The APP might not include peak expiratory flow monitoring and oral corticosteroid self-administration for both the MART and ICS/LABA + SABA regimens and might not add SABA together with ICS dose escalation for the ICS/LABA + SABA regimen. Conclusions: This study established an expert consensus on fundamental AAP structural elements and actions for the Vietnamese. The failure to achieve consensus on PEF monitoring tools and OCS for the self-management of asthma exacerbation reflects concerns about medication abuse, especially in Vietnamese healthcare settings.

Background/Objectives: Asthma action plans (AAP) are recommended for patients’ self-management of asthma and should be adapted countries’ situation. This study aimed to develop expert consensus on the optimal structure and content and action of asthma action plans for Vietnamese settings to ensure feasibility, acceptance and implementation. Methods: A Delphi consensus conducted over two rounds. The proposed items were evaluated by a Vietnamese panel of pulmonologists, allergist, tuberculosis/lung disease specialists and general practitioners. Structured online questionnaires with 5-point Likert scales were used. Consensus was defined as >80% agreement and < 10% strong disagreement. Results: 26 and 21 participants completed round 1 and round 2, respectively. 4-zone of AAP was preferred (42.3%) over 3-zone (38.5%) or 2-zone (19.2%). AAP should include some key statements for asthma, symptoms for self-monitoring, objective asthma control questionnaire, actions for changes of maintenance medication and instructions in emergency situations. AAP zones should be classified on symptom frequency and severity. Patient actions should be tailored to their treatment regimen (MART or ICS/LABA + SABA). APP might not include peak expiratory flow monitoring and oral corticosteroid self-administration for both MART and ICS/LABA + SABA regimen, and might not add SABA together with ICS dose escalation for ICS/LABA + SABA regimen. Conclusions: This study established an expert consensus on fundamental AAP structural elements and actions for the Vietnamese. The failure to achieve consensus on PEF monitoring tools and OCS for self-management of asthma exacerbation reflects concerns about medication abuse, especially in Vietnam healthcare settings.