Global Bridges - Eastern Europe


IPCRG ran a Teach the Teacher: Treating Tobacco Dependence project between December 2016 and March 2019 in eastern Europe.

This was one of eleven projects focused on treating tobacco dependence in the World Health Organization (WHO) European Region. The grants were awarded in 2016, following a competitive review of proposals to Global Bridges and Pfizer Independent Grants for Learning and Change for projects that will help more Europeans improve their health by stopping tobacco use with support from healthcare professionals. We adopted IPCRGs  Teach the Teacher (3-tier educational model) as a method to develop a sustainable network of teachers to increase the capacity of primary care professionals (PCPs) to treat tobacco dependence (TD) when applied in a collaborative programme across four eastern European countries.

Our collaborators were :

  • Bulgarian General Practice Society for Research and Education.
  • Centre for Family Medicine, Medical Faculty, University Ss Cyril and Methodius, Skopje, North Macedonia.
  • Kyrgyz Thoracic Society
  • RespiRo (National Centre for Studies in Family Medicine and the National Society of Family Doctors) Organization, Romania.  

We established an IPCRG expert faculty who designed a core curriculum and education programme for an international meeting of project partners.

  • Dr Andy McEwen, an expert in evidence-based behaviour change techniques and Executive Director of the National Centre for Smoking Cessation & Training;
  • Dr Noel Baxter, a GP and Clinical Lead for Stop Smoking;
  • Dr Jaime Correia de Sousa, a senior academic teacher for family medicine;
  • Darush Attar-Zadeh, an experienced community pharmacist and trainer for smoking. 

Tier 1: International Meeting: March 2017 - Sofia, Bulgaria.

  • International Teachers Workshop (Tier 1) 2017-03. 19 teachers from four countries plus 4 Faculty. We designed a core curriculum and established community of knowledge and practice.
  • Adapted Very Brief Advice Treat TD protocol (3As: Ask, Advise, Act) for in-country work: “VBA Plus”. VBA 'Act' protocol adapted to limited/no access to evidence-based treatments including nicotine replacement therapy and specialist behavioural counselling.

Tier 2: 

In 2018, the four participating countries conducted tier two programmes of education to prepare primary care educators or ‘national master teachers’ to develop in-country programmes of education for primary care professionals.  

  • In-country teaching of primary care educators 117 (Tier 2) in four countries 2017-10
  • Additional input to national CME events and specialist conferences
  • Primary Care Educators: Romania 32; Kyrgyzstan 39; Republic of North Macedonia 25; Bulgaria 21

Tier 3:

Subsequently, the primary care educators ran VBA+ education programmes for primary care professionals (tier 3) in different regions, within four countries. The programme successfully rolled out to tier three, in four participating countries. 

  • In-country teaching of 985 Primary Care Professionals (Tier 3) in four countries 2019-03. 
  • Primary Care Professionals: Romania 456; Kyrgyzstan 200; Republic of North Macedonia 225; Bulgaria 104



We used an adapted model1 to evaluate education events and the intervention as a whole2. We evaluated education events using observation, pre and post knowledge assessment, narrative reports, photographic and video evidence. We worked with our partners to explore impact evaluation using narrative and primary care data. We developed case studies which describe the work in four different contexts - Romania, Bulgaria, North Macedonia and Kyrgyzstan and insights for the intervention/ programme  overall. The evaluation indicates:

  • Positive response and confidence to treat TD using VBA plus.
  • Some impact evidenced/ some challenges in systematic data collection/ data analysis.
  • Global impact: Presentations at ENSP conference 2018-05; IPCRG World conference 2018-05.
  • Evidence of influence on tobacco control and policy developments within countries.
  • Creation of new local networks and partnerships to build on the project.


We published an IPCRG Desktop Helper on Helping Patients quit Tobacco, which includes VBA Plus and MI and was authored by one of the expert faculty, Noel Baxter, and reviewed by another, Darush Attar-Zadeh as well as other experienced clinicians in the IPCRG network. It was influenced by the experience of delivering VBA in the Global Bridges project as well as other programmes like FRESH AIR

A second related publication is the PCRS Pragmatic Guides for Clinicians Diagnosis and Management of Tobacco Dependency. Si├ón Williams is one of the authors and several members of our expert faculty for the Global Bridges TTD project in Eastern Europe were also involved including Dr Noel Baxter, Darush Attar-Zadeh and Dr Andy McEwen. Pfizer provided an educational grant, but had no input into scoping, researching or writing the guide.