Introduction:
Tobacco cessation training programs are scarce in Spanish speaking low-income countries. The Fruitful Study adapted, implemented and evaluated an online smoking cessation training addressed to workers from Bolivia, Guatemala and Paraguay. The aim of this study is to examine changes in hospital workers’ interventions before and after the online training.

Methods:
Pre-post evaluation of the self-reported performance of the 5A’s by hospital workers from the three involved organizations. We assessed individual, behavioral, and organizational-level factors through a questionnaire that included 43 items (0=none to 10=most possible) completed before and six months after the training. Medians and interquartile ranges were computed. To examine changes, the non-parametric test for paired data (Wilcoxon) was used.

Results:
202 professionals (76 in Bolivia, 79 in Guatemala, and 47 in Paraguay) finished the course, of them 99 (28, 42, and 29 respectively) completed both questionnaires before and after the training. Overall, there was an increase in the performance of the each of the 5A’s components [Ask (7.5 to 9); Advise (7 to 9); Assess (6 to 8); Assist (2 to 7); and Arrange a follow up (0.5 to 5); all p <0.001]. Doctors, former smokers, and those from Paraguay obtained higher scores. The level of perception of the participants degree of preparedness, level of competence and, familiarity with resources increased (p <0.001).

Conclusions:
The online training had a positive impact in the implementation of the brief intervention. Online education in tobacco cessation is feasible and effective to improve tobacco cessation interventions in these countries

Funding:
This study has been funded by Global Bridges Mayo Clinic (Pfizer Medical Group; GB-13520139: Development and Dissemination of a Tobacco Cessation Training Program for Healthcare Professionals in Spanish-speaking Countries). Moreover, CM and EF are also funded by the Spanish Government (Instituto de Salut Carlos III, grant PI15-00875) and the Catalan Government (Xarxa Catalana d’Hospitals sense fum, Agència de Salut Pública de Catalunya, contracte Nº 2015VAR171)