Background:
Tobacco cessation training programs are scarce in Spanish speaking low-income countries. Based on a previous program developed in Spain, the Fruitful Study adapted, implemented and evaluated the effectiveness of an online brief intervention smoking cessation training program addressed to hospital workers from Bolivia, Guatemala and Paraguay. The aim of this study is to examine the degree of implementation of the 5A brief intervention model before and after the training and identify changes in cognitive, behavioral factors and in the perception of organizational support.

Methods:
Pre-post evaluation through a questionnaire that evaluated 43 items previously identified in the literature. The questionnaires were completed immediately before and six months after the course. To examine pre-post changes in scores, the non-parametric test for paired data (Wilcoxon) was used.

Results:
202 professionals completed the questionnaires before and after the course. For this analysis, only those with clinical tasks (n = 154) were selected (57.1% were Doctors, 31.2% were Nurses, 11.7% were Other professionals). Overall, significant increases were achieved in all components of the brief intervention [Ask (5.5 to 7.6); Advise (5.9 to 8.0); Assess (5.0 to 7.1); Assist (2.7 to 5.8); and Arrange a follow up (1.8 to 5.1); p < 0.001 for all components]. Doctors and Other Health professionals obtained higher scores compared to Nurses. By country, the health workers from Paraguay obtained higher scores. Overall, the perception of the degree of preparation, preparedness in the management of medication, level of competence and, familiarity with resources such as quitlines, Internet, etc, increased (p < 0.001).

Conclusions:
The online training had a positive impact on the implementation of the brief intervention in the three countries. Online education in tobacco cessation is feasible and effective to improve evidence-based treatment for tobacco dependence in these countries