Background:
Community health workers (in Vietnam referred as village health workers - VHWs) have potential to play a key role in expanding access to evidence-based tobacco use treatment. VHWs can help smokers quit by asking patients about tobacco use, advising them to quit, and offering cessation assistance (3As). We are conducting a NIH funded cluster randomized controlled trial comparing two strategies for implementing tobacco use treatment guidelines (TUTG) in commune health centers (CHCs) in Vietnam: brief provider counseling + self-help materials (BC) vs. BC + 3 sessions of in person counseling delivered by a VHW. This paper presents data on the effect of the intervention on VHWs' practice patterns and attitudes towards TUTG.

Methods:
We examined changes in adherence to TUTG before and 12 months after the intervention with 89 VHWs working in 13 CHCs in Vietnam. Adherence to each of the 3As was measured using a 5-point likert scale: from 1-none (did not ask any patients in past month if they smoke), to 5-all or most of patients. Response scales of questions measuring attitudes and self-efficacy range from 1-strongly disagree to 4-strongly agree. Factor analysis was used to form two scales measuring attitudes and self-efficacy.

Results:
The mean adherence level to each of the TUTG increased significantly: Asking about tobacco use increased from 1.79±0.57 to 2.61±0.96; advising to quit from 1.93±0.60 to 2.90±1.11; assisting from 1.53±0.62 to 2.65±1.19. Perceived barriers to treating tobacco use decreased significantly. Self-efficacy and attitudes towards TUTG improved significantly. Increased adherence to TUTG was associated with positive attitudes towards TUTG.

Conclusions:
The implementation strategies were effective in improving VHWs' adherence to TUTG. Extending VHWs' role to include smoking cessation could offer a sustainable supporting resource for tobacco smokers who wish to quit.