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      Adaptation, Implementation Plan, and Evaluation of an Online Tobacco Cessation Training Program for Health Care Professionals in Three Spanish-Speaking Latin American Countries: Protocol of the Fruitful Study

      , RN, BSc, PhD 1 , 2 , 3 , , , MD 4 , , BA 4 , 5 , , MD 6 , , MD 7 , , MD 8 , , MD, MPH, PhD 2 , 5 , 9 , , Group of Hospital Coordinators in the Fruitful Project 6 , 7 , 8
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      tobacco cessation, online, training, low- and middle-income countries, policies

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          Tobacco cessation training programs to treat tobacco dependence have measureable effects on patients’ smoking. Tobacco consumption in low- and middle-income countries (LMICs) is high and slowly decreasing, but these countries usually lack measures to face the epidemic, including tobacco cessation training programs for health professionals and organizations. Based on a previous online smoking cessation training program for hospital workers in Spain, the Fruitful Study aims to increase smoking cessation knowledge, attitudes, self-confidence, and performance interventions among health care professionals of three Spanish-speaking low- and middle-income Latin American and Caribbean (LAC) countries.


          The purpose of this paper is to describe the methodology and evaluation strategy of the Fruitful Study intended to adapt, implement, and test the effectiveness of an online, evidence-based tobacco cessation training program addressed to health professionals from Bolivia, Guatemala, and Paraguay.


          This study will use a mixed-methods design with a pre-post evaluation (quantitative approach) and in-depth interviews and focus groups (qualitative approach). The main outcomes will be (1) participants’ attitudes, knowledge, and behaviors before and after the training; and (2) the level of implementation of tobacco control policies within the hospitals before and after the training.


          To date, adaptation of the materials, study enrollment, and training activities have been completed. During the adaptation, the main mismatches were language background and content adaptation. Several aids were developed to enable students’ training enrollment, including access to computers, support from technicians, and reminders to correctly complete the course. Follow-up data collection is in progress. We have enrolled 281 hospital workers. Results are expected at the beginning of 2017 and will be reported in two follow-up papers: one about the formative evaluation and the other about the summative evaluation.


          There is a need to learn more about the cultural and content elements that should be modified when an online tobacco cessation training program is adapted to new contexts. Special attention should be given to the personal and material resources that could make the implementation possible. Results from the Fruitful Study may offer a new approach to adapting programs to LMICs in order to offer education solutions with the use of emerging and growing communication technologies.


          Clinicaltrials.gov NCT02718872; https://clinicaltrials.gov/ct2/show/NCT02718872 (Archived by WebCite at http://www.webcitation.org/6mjihsgE2)

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          How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.
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                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                January 2017
                27 January 2017
                : 6
                : 1
                : e7
                [1] 1Institut Català d’Oncologia-ICO Tobacco Control Unit, Cancer Control and Prevention Programme L'Hospitalet del LlobregatSpain
                [2] 2Cancer Control and Prevention Group Institut d’Investigació Biomèdica de Bellvitge-IDIBELL L’Hospitalet de LlobregatSpain
                [3] 3Universitat Internacional de Catalunya Medicine and Health Sciences School Sant Cugat del VallésSpain
                [4] 4Institut Català d’Oncologia-ICO Training Unit L’Hospitalet de LlobregatSpain
                [5] 5Institut Català d’Oncologia-ICO Tobacco Control Unit, Cancer Control and Prevention Programme L’Hospitalet de LlobregatSpain
                [6] 6Management Department Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra Santa Cruz de la SierraBolivia
                [7] 7Public Health Department Ministerio de Salud y Pública y Bienestar Social AsuncionParaguay
                [8] 8Radiation Oncology Department Instituto de Cancerología y Hospital Dr. Bernardo GuatemalaGuatemala
                [9] 9School of Medicine Department of Clinical Sciences Universitat de Barcelona L'Hospitalet del LlobregatSpain
                Author notes
                Corresponding Author: Esteve Fernández efernandez@ 123456iconcologia.net
                Author information
                ©Cristina Martínez, Assumpta Company, Olga Guillen, Mercè Margalef, Martha Alicia Arrien, Claudia Sánchez, Paula Cáceres de León, Esteve Fernández, Group of Hospital Coordinators in the Fruitful Project. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 27.01.2017.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                : 11 August 2016
                : 8 September 2016
                : 21 October 2016
                : 23 November 2016

                tobacco cessation,online,training,low- and middle-income countries,policies


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