{
  "abstract": "Introduction\n\nTobacco-related morbidity and mortality are increasingly shifting toward low- and middle-income countries (LMICs), with most smokers beginning during adolescence. In Kyrgyzstan, adolescent-specific cessation services are not yet systematically integrated into primary care. This study aimed to culturally and contextually adapt Very Brief Advice Plus (VBA+) to the local context, implement the intervention, and evaluate healthcare professionals' implementation behaviors and determinants following training.Methods\n\nThis mixed-methods implementation study was conducted in six Family Medicine Centers in Kyrgyzstan as part of FRESHAIR4Life (2023-2026). VBA+ was adapted for adolescents (aged 14-21 years) through iterative stakeholder reviews to ensure contextual relevance. In total, 56 healthcare providers (HCPs) participated in the study and completed the Determinants of Implementation Behavior Questionnaire (DIBQ) to assess changes in implementation determinants following training on a five-point Likert scale. Qualitative data were collected through semi-structured interviews with 16 HCPs and analyzed using a framework approach, with deductive coding informed by the Theoretical Domains Framework and inductive coding to explore HCPs' experiences in delivering the intervention.Results\n\nHCPs initially reported high mean scores of knowledge (3.97) and perceived VBA+ as highly compatible with their professional roles (role and identity; 3.91). At follow-up, construct scores for attitude (mean change= -0.41; p=0.007), reinforcement (-0.57; p=0.019), and memory (-0.52; p=0.023) had decreased significantly, while priority remained the lowest rated determinant (mean=2.61). Qualitative data indicated that training facilitated a shift from authoritarian to empathetic, youth-centered communication. Significant barriers included the presence of parents during consultations and gaps in knowledge regarding emerging products like naswar and e-cigarettes. The use of WhatsApp 'nudges' and peer support facilitated sustained implementation.Conclusions\n\nThis study demonstrates that VBA+ can be feasibly adapted and delivered by trained HCPs in primary care in Kyrgyzstan. Further studies are needed to evaluate its effectiveness and sustainability at a larger scale before broader scale-up can be recommended.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.",
    "Pulmonology Department, National Centre of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.",
    "International Primary Care Respiratory Group (IPCRG), London, United Kingdom.",
    "Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.",
    "Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland.",
    "Usher Institute, University of Edinburgh, Edinburgh, Scotland.",
    "Department of Health Sciences, University of York, York, United Kingdom.",
    "Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Julia M van Koeveringe"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Gulzada Mirzalieva"
    },
    {
      "affs": [
        1
      ],
      "name": "Aijan Taalaibekova"
    },
    {
      "affs": [
        1
      ],
      "name": "Maamed Mademilov"
    },
    {
      "affs": [
        1
      ],
      "name": "Azat Bolotbek Uulu"
    },
    {
      "affs": [
        2
      ],
      "name": "Darush Attar-Zadeh"
    },
    {
      "affs": [
        2
      ],
      "name": "Luis Carvalho"
    },
    {
      "affs": [
        3
      ],
      "name": "Rianne Mjj van der Kleij"
    },
    {
      "affs": [
        4
      ],
      "name": "Nadia Rahim"
    },
    {
      "affs": [
        5
      ],
      "name": "Purva Abhyankar"
    },
    {
      "affs": [
        6
      ],
      "name": "Faraz Siddiqui"
    },
    {
      "affs": [
        1
      ],
      "name": "Talant Sooronbaev"
    },
    {
      "affs": [
        0
      ],
      "name": "Onno Cp van Schayck"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Floor A van den Brand"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9j4cek072q2hw.bib",
  "cited_by": 0,
  "doi": "10.18332/tpc/230938",
  "fulltext_url": "https://europepmc.org/articles/PMC13693424",
  "id": "9j4cek072q2hw",
  "issns": [
    "2459-3087"
  ],
  "landing_url": "https://europepmc.org/article/MED/42921182",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2737|Smoking Behavior and Cessation"
    ]
  ],
  "openalex": "W7223329546",
  "pdf_url": "https://europepmc.org/articles/PMC13693424?pdf=render",
  "pmcid": "PMC13693424",
  "pmid": "42921182",
  "published": "2026-10-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/9j4cek072q2hw.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42921182",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42921182"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Smoking Behavior and Cessation",
      "subfield": "physiology"
    }
  ],
  "title": "Adapting and implementing very brief advice+ (VBA+) in primary care to promote adolescent smoking cessation in Kyrgyzstan: A mixed-methods FRESHAIR4Life study.",
  "title_text": "Adapting and implementing very brief advice+ (VBA+) in primary care to promote adolescent smoking cessation in Kyrgyzstan: A mixed-methods FRESHAIR4Life study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:33Z",
  "url": "https://research.draconitic.com/paper/9j4cek072q2hw",
  "venue": "Tobacco prevention & cessation",
  "versions": []
}