Training general practitioners in Greece in ‘Very Brief Advice’ on smoking: The FRESH AIR Project
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Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece
National Centre for Smoking Cessation and Training, London, United Kingdom
Publication date: 2022-07-05
Tob. Prev. Cessation 2022;8(Supplement):A43
Greece has the highest rates of smoking in the European Union. However, smoking cessation advice and treatment is limited, especially in primary care.

This pilot study explored whether training in ‘Very Brief Advice (VBA)’ on smoking results in changes in VBA confidence and delivery among general practitioners (GPs) in Crete, Greece.

A mixed-methods, pre-post evaluation study was undertaken. The 1-day VBA training developed by UK’s National Centre for Smoking Cessation and Training was locally adapted and delivered to a purposively selected sample of GPs. GPs’ selfefficacy (1–5 scale), self-reported practice behaviors related to VBA (ASK, ADVICE, ACT) and satisfaction with the training were assessed through questionnaires before, immediately after and one month following the training. Changes in outcomes were explored through Cochran’s Q tests with post hoc McNemar’s test, or Friedman’s tests with post hoc Wilcoxon Signed Rank tests. Semi-structured interviews were also conducted to assess training acceptability and feasibility.

Twenty-nine GPs participated in the pilot training [62.1% male, median (IQR) age: 44.5 (5.8) years]. The majority (79.3%) reported that the training improved their skills and that they would recommend it to others (93.1%). Statistically significant increases were found pre vs post training in GPs’ self-efficacy in advising patients on the best methods to quit [median (IQR) score: 3 (1) vs 5 (2), p=0.002] and providing cessation support [median (IQR) score: 3 (0) vs 4 (2), p=0.030]. Qualitative interviews indicated that the training increased GPs’ persistence in addressing smoking and improved their communication style. However, further training is needed to enhance skills in addressing smoking with patients with low motivation/confidence to quit.

The VBA training was well-received by participating GPs and increased self-efficacy and rates at which they addressed smoking. Training GPs in VBA may offer a low cost and promising strategy for addressing tobacco use, when tailored to local contexts.