Preventing tobacco use among adolescents in FreshAir4Life countries: A mixed method, RE-AIM evaluation of implementation intentions delivered in youth clubs in Karachi, Pakistan

Background: Implementation intentions is an evidence-based behavioural intervention which is yet to be evaluated in diverse settings. This study will evaluate the delivery of Implementation Intentions for preventing tobacco uptake among adolescents in youth football clubs in Karachi, Pakistan, within the larger FreshAir4Life programme. Research Questions: The RE-AIM framework will be used to explore: 1. What factors influence adolescents’ engagement with the intervention? How can participation and engagement be improved? (R) 2. Are adolescents likely to become less susceptible towards tobacco products following engagement with the intervention? What factors (individual and household) determine their response to the intervention (and how)? (E) 3. To what extent do the implementation strategies (adaptation, training, ongoing support) influence the adoption (A), adherence and quality of intervention delivery (I)? Do other factors (individual, organisational or contextual) influence? 4. Is the intervention likely to be sustained beyond the project? What modifications can sustain the intervention (and how)? What are the potential barriers? (M) Methods: A mixed-method, before-after evaluation will be conducted. In the pre-implementation phase, questionnaires will be used to collect data on socio-demographic characteristics, tobacco use and susceptibility (adolescents, n=180), and preparedness to deliver implementation intentions (coaches, n=22). During implementation, session logs will be maintained and observations of group sessions conducted to assess fidelity. In the post-implementation phase, questionnaires will assess change in tobacco use status and susceptibility to tobacco (adolescents) - qualitative interviews will explore barriers and facilitators to participation and engagement (adolescents) and the experience of delivering group sessions (coaches), focusing on adoption, implementation fidelity and maintenance. Quantitative data will be analysed descriptively, while qualitative data will be analysed using thematic framework analysis. Anticipated impact: Implementation intentions can potentially benefit youth in diverse and non-academic settings. The proposed evaluation will provide insights which will support its wider implementation and scale-up in Pakistan.