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Welcome to the IPCRG & Global Bridges Project:

Teaching the teachers of primary healthcare professionals to treat tobacco dependence 

Following the success of our programme in Uganda, the IPCRG is delighted to announce that we will be running one of 11 new projects focused on treating tobacco dependence in the World Health Organization (WHO) European Region. The grants were awarded following a competitive review of proposals to Global Bridges and Pfizer Independent Grants for Learning and Change for projects that will help more Europeans improve their health by stopping tobacco use with support from healthcare professionals.

Project summary

The International Teachers Workshop is an important first stage of this work, which seeks to build capacity for treating tobacco dependence in four countries within the WHO eastern European region. We propose to teach a small group of teachers from four countries (Bulgaria, Romania, Republic of Macedonia and Kyrgyz Republic) who are involved in continuing medical education, the skills and knowledge required to develop in-country programmes of education to treat tobacco dependence in primary care. These teachers will then adapt the resources for their own context and develop a programme of in-country workshops for primary care educators. In a third level, primary care educators will deliver education modules to improve knowledge, skills and confidence for treating tobacco dependence in their community.




Understanding the Global Context 

World Health Organization Framework Convention on Tobacco Control

Article 14: Demand reduction measures concerning tobacco dependence and cessation


Understanding the national context and policy

We used Martin Raw's 2007 work which describes a survey of national tobacco dependence treatment services in 36 countries. The objective was to describe the services and discuss the results in the context of Article 14 of the Framework Convention on Tobacco Control, which asks countries to promote adequate treatment for tobacco dependence. 

We adapted Raw's survey to review tobacco dependence services in each of the four countries included in this project. Sample surveys:  

ipcrg tobacco_survey country sit-analysis jan2017.pdf

ipcrg tobacco_survey in-country teachers jan 2017.pdf



International Teachers Workshop - March 2017

Session 1: Overview of the Global Bridges Project and the IPCRG context

Welcome to the workshop - Jaime & Juliet presentation 

Int Teachers Workshop Intro.pptx

Session 2: What is VBA – the UK model – beliefs about smoking - why treat tobacco dependence? 

  1. The harmful effects of smoking – blind spots and golden opportunities to intervene
    Noel's presentation - 
    NB TTT Tobacco .pptx
  2. Tobacco dependence: why smokers don’t just stop
  3. The place of smoking cessation in tobacco control (triggering, and assisting with, quit attempts)
  4. What is Very Brief Advice (VBA), does it work and will it work for you?

Andy's presentations - VBA training resources 

N.B: these are draft resources/ templates which we expect that in-country teams will need to adapt to their context.

1. Key learning outcomes.docx1. Key learning outcomes.docx

2. Timetable.docx

3. VBA presentation.pptx

4. VBA Training Manual.docx

5. Patient responses.docx

6. VBA smokers questions.docx

A. Key learning VBA on Smoking.docx

B. VBA resource card.docx

Hierarchy of smoking cessation interventions.docx

Other resources

  • This is the project that Noel Baxter talked about - the London Clinical Senate established a Helping Smokers Quit Programme which ran until May 2016. The final report is easy to use and highly pictorial and gives an overview of this work. It might encourage people to consider the ways in which they may influence beyond the classroom.

INDN_2015_1_17-21Smoking final.pdf

  • The Behaviour Change Wheel -  a Guide to Designing InterventionsSusan Michie, Lou Atkins & Robert West

The behaviour change wheel

  • National Centre for Smoking Cessation & Training ( NCSCT) - into to VBA

Short film on Very Brief Advice ( VBA) 

  • Fagerstrom test for nicotine dependence - the test 

Session 3: Support and medication

  1. Stop smoking medications: theory and practice
  2. Behavioural support: behaviour change techniques, including use of carbon monoxide (CO) monitors
  3. Adding behavioural support to medication
  4. What is available - understand the relative value of specific pharmacotherapy and non-pharmacotherapy  interventions, how to prescribe safely and effectively 
  5. Avoiding under-dosing and managing the fear of stop smoking drugs

Darush's presentation 

Advisor Handbook IPCRGv.doc

  • Fagerstrom test for nicotine dependence - the test 
  • Darush uses the Fargerstrom test in consultations to 'build a picture of his patients world' and tobacco use.  

Session 4: Ask, Advise, Act – a more in-depth session on each of the stages – guidance and practice sessions

 Differentiating VBA from treatment of tobacco dependence (Noel's comments after lunch). 

  • Ask – including notes and recording smoking status 
  • Advise - tailoring the advice
  • Act - connect with what’s available


Session 5:  Barriers and frequently asked questions 


Session 6: e-cigarettes – what is the evidence?  IPCRG position paper, main debates 

Key Resources 

IPCRG position paper

Short films online: the National Centre for Smoking Cessation Training UK, and the New Nicotine Alliance have produced a short film which explores how some people have switched from smoking cigarettes to vaping (2017). 


Session 7: Sharing experiences of teaching and learning in primary care

  • Defining learning objectives
  • Designing a learning programme
  • Leading a session
  • Available training resources
  • Assessing/evaluating learning
  • Fidelity – how do we work with a cascade process of training?

Session 8:  Review and discussion – what’s available in-country and consider how services can approach advice based on what is available 


Session 9: Assessing Learning and Evaluating Impact


Key Resources 


Global Bridges: Example evaluation resources from previous projects  2015 

American University of Armenia,  2015. 

Pharmacotherapy questionnaire - to help understand availability, affordability and prices of smoking cessation products in- country and to make comparisons across the countries that are Global Bridges grantees     - Pharmacotherapy Questionnaire_Global Bridges_MRedits.docx


Tbilisi, Georgia. Evaluation of Global Bridges Project 2015. 

This is a simple pre-assessment of knowledge questionnaire - 2_Pre-course quiz-Georgia.doc

This is a PowerPoint presentation illustrating an assessment of knowledge post training - 8PPT for Day 3-closure.ppt


King Hussein Cancer Centre, Jordan.  Evaluation of Global Bridges Project  2015. 

This is a publication resulting from a previous Global Bridges project by Feras I. Hawari, Rasha K. Bader, Nour A. Obeidat, Hiba S. Ayub, Iyad M. Ghonimat,J. Taylor Hays, and Richard D. Hurt, from the Cancer Control Office, King Hussein Cancer Center, Amman, Jordan.

Title: Influencing Readiness and Intentions to OfferTobacco Dependence Treatment Through Training: King Hussein Cancer Centre and Global Bridges Promoting an Underutilised Specialty in the Eastern Mediterranean Region - Influencing.pdf

This is a baseline questionnaire to collect demographic information and includes a pre assessment of knowledge on treating tobacco dependence - Registration form.pdf

Example: simple participant satisfaction questionnaire from the KHCC team  - Evaluation form.xlsx


The Kyrgyz Republic is also participating in the FRESH AIR programme set up by the IPCRG.  This looks at how to implement interventions to reduce exposure not only to tobacco smoke but also smoke from using biomass fuel for cooking and heating.   A similar approach was also followed in the first IPCRG Global Bridges scheme in Uganda.




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