Adapting and implementing very brief advice+ (VBA+) in primary care to promote adolescent smoking cessation in Kyrgyzstan: A mixed-methods FRESHAIR4Life study.
8 affiliations
- 1Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- 2Pulmonology Department, National Centre of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
- 3International Primary Care Respiratory Group (IPCRG), London, United Kingdom.
- 4Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
- 5Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland.
- 6Usher Institute, University of Edinburgh, Edinburgh, Scotland.
- 7Department of Health Sciences, University of York, York, United Kingdom.
- 8Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
Abstract
Introduction
Tobacco-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
This 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
HCPs 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
This 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.
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BibTeX
@article{koeveringe2026adapting,
title = {{Adapting and implementing very brief advice+ (VBA+) in primary care to promote adolescent smoking cessation in Kyrgyzstan: A mixed-methods FRESHAIR4Life study.}},
author = {Julia M van Koeveringe and Gulzada Mirzalieva and Aijan Taalaibekova and Maamed Mademilov and Azat Bolotbek Uulu and Darush Attar-Zadeh and Luis Carvalho and Rianne Mjj van der Kleij and Nadia Rahim and Purva Abhyankar and Faraz Siddiqui and Talant Sooronbaev and Onno Cp van Schayck and Floor A van den Brand},
journal = {Tobacco prevention \& cessation},
year = {2026},
month = oct,
doi = {10.18332/tpc/230938},
url = {https://europepmc.org/article/MED/42921182},
note = {CC BY},
}
RIS
TY - JOUR
TI - Adapting and implementing very brief advice+ (VBA+) in primary care to promote adolescent smoking cessation in Kyrgyzstan: A mixed-methods FRESHAIR4Life study.
AU - Julia M van Koeveringe
AU - Gulzada Mirzalieva
AU - Aijan Taalaibekova
AU - Maamed Mademilov
AU - Azat Bolotbek Uulu
AU - Darush Attar-Zadeh
AU - Luis Carvalho
AU - Rianne Mjj van der Kleij
AU - Nadia Rahim
AU - Purva Abhyankar
AU - Faraz Siddiqui
AU - Talant Sooronbaev
AU - Onno Cp van Schayck
AU - Floor A van den Brand
PY - 2026
DA - 2026/10/23
JO - Tobacco prevention & cessation
DO - 10.18332/tpc/230938
UR - https://europepmc.org/article/MED/42921182
AB - Introduction Tobacco-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 This 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 HCPs 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 This 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.
SN - 2459-3087
ER -