A systematic approach to selecting and adapting evidence-based air quality interventions in five diverse settings

Research Question: How can we adapt strategies to implement air quality interventions to five diverse settings? Background: Tobacco-use and air pollution account for nearly 30% of the world’s non-communicable disease burden, often disproportionately affecting disadvantaged populations. Despite evidence-based interventions for reducing risk factors (recommended ‘best buys’ by the WHO), they are rarely implemented in practice. ‘Fresh Air for Life’ aims to optimise the implementation of such interventions targeting adolescents’ exposure to tobacco and pollution in five diverse countries: Greece, Romania, Kyrgyzstan, Pakistan and Uganda. A situational analysis to understand the local context and needs will inform the selection and adaptation of interventions from the ‘best-buy palette’, which will subsequently be implemented and evaluated. ‘Best-buy’ interventions are typically developed and evaluated in high-income countries, and tailored to that setting. Implementation in different socio-economic, cultural and geo-political contexts, requires careful selection and adaptation of implementation strategies so that effectiveness is optimised within the specific context. We present a systematic approach to selecting and adapting evidence-based interventions using contextual understanding from the situational analysis and local stakeholder involvement. Method (See figure): Step 1: Identify barriers and facilitators (B&Fs) to target behaviours from each country’s situational analysis and using behavioural and implementation theories, classify into individual, social and community, and context level. Step 2: For each level, identify techniques/strategies required to facilitate desired change from existing evidence and contextual understanding including Behaviour Change Techniques (BCTs), implementation strategies and system level changes. Step 3: Identify suitable interventions (e.g. covering the required BCTs), indicate adaptation requirements (e.g. addition of BCTs not yet covered) and develop implementation strategies to deliver interventions (e.g. who, what, where, when) (noting recommendations for system level policy/regulatory interventions unlikely to be addressed in FA4Life). Step 4: Hold local stakeholder workshops to make collaborative decisions on intervention selection, adaptation and implementation strategies.