COmmunities Facilitating incREasing Smoke-free Homes (CO-FRESH): co-developing a toolkit with local stakeholders in Indonesia and Malaysia.

Introduction: Exposure to secondhand tobacco smoke generates a considerable health burden globally. In South-East Asia, most of that burden falls on women and children who are exposed to secondhand smoke (SHS) from male smoking in their home. Interventions to encourage smoke-free homes have tended to target people who smoke individually or within their family unit, although some evidence suggests a community-wide approach holds promise. The aim of this study was to codevelop a toolkit to increase the uptake of smoke-free homes within small village/town communities in Indonesia and Malaysia.

Methods: During 2022/3, the CO-FRESH (COmmunities Facilitating incREasing Smoke-free Homes) study engaged with local community members in three villages in central Malaysia and one subdistrict in Indonesia. This toolkit-development study co-created: (1) online training materials to equip local health professionals to tackle smoking in the home; (2) a local public information campaign on the benefits of a smoke-free home; (3) methods to provide household air quality feedback to highlight the impact of smoking in the home; and (4) information on local services to support families to create smoke-free homes.

Results: Communities welcomed the concept of tackling smoking in the home; however, there was limited knowledge about how SHS moved around the home and could enter indoor spaces from outdoor smoking. There were differences in the conceptualisation of what defined a 'smoke-free' home, alongside the delineation of indoor and outdoor spaces within the home setting. In addition, findings of high background air pollution levels mean that household air quality measurement may not be suited to providing SHS information in these communities.

Conclusions: Communities in Malaysia and Indonesia recognised the importance of reducing smoking in the home and welcomed the approach of co-developing community-wide methods of tackling the issue. The CO-FRESH toolkit requires evaluation to determine effectiveness and how it can be implemented at scale.