title: 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.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02718872; https://clinicaltrials.gov/ct2/show/NCT02718872 (Archived by WebCite at http://www.webcitation.org/6mjihsgE2).
authors.affiliation: Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet del Llobregat, Spain.|Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.|Universitat Internacional de Catalunya, Medicine and Health Sciences School, Sant Cugat del Vallés, Spain.
authors.forename: Cristina
authors.identifier: http://orcid.org/0000-0002-0108-3288
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Institut Català d'Oncologia-ICO, Training Unit, L'Hospitalet de Llobregat, Spain.
authors.forename: Assumpta
authors.identifier: http://orcid.org/0000-0001-6259-1705
authors.initials: A
authors.lastname: Company
authors.affiliation: Institut Català d'Oncologia-ICO, Training Unit, L'Hospitalet de Llobregat, Spain.
authors.forename: Olga
authors.identifier: http://orcid.org/0000-0002-1870-6875
authors.initials: O
authors.lastname: Guillen
authors.affiliation: Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet de Llobregat, Spain.
authors.forename: Mercè
authors.identifier: http://orcid.org/0000-0001-8427-1403
authors.initials: M
authors.lastname: Margalef
authors.affiliation: Management Department, Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia.
authors.forename: Martha Alicia
authors.identifier: http://orcid.org/0000-0002-0042-6402
authors.initials: MA
authors.lastname: Arrien
authors.affiliation: Public Health Department, Ministerio de Salud y Pública y Bienestar Social, Asuncion, Paraguay.
authors.forename: Claudia
authors.identifier: http://orcid.org/0000-0003-0801-5277
authors.initials: C
authors.lastname: Sánchez
authors.affiliation: Radiation Oncology Department, Instituto de Cancerología y Hospital Dr. Bernardo, Guatemala, Guatemala.
authors.forename: Paula
authors.identifier: http://orcid.org/0000-0002-1931-7898
authors.initials: P
authors.lastname: Cáceres de León
authors.affiliation: Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.|Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet de Llobregat, Spain.|School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, L'Hospitalet del Llobregat, Spain.
authors.forename: Esteve
authors.identifier: http://orcid.org/0000-0003-4239-723X
authors.initials: E
authors.lastname: Fernández
authors.affiliation: Management Department, Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia.|Public Health Department, Ministerio de Salud y Pública y Bienestar Social, Asuncion, Paraguay.|Radiation Oncology Department, Instituto de Cancerología y Hospital Dr. Bernardo, Guatemala, Guatemala.
keywords: low- and middle-income countries; online; policies; tobacco cessation; training