Impact of training on the implementation of group-based smoking cessation in primary care

Background and objectives

Under EU Joint Action EU4Health, the Directorate General of Public Health and IDIVAL are implementing a group-based tobacco and nicotine cessation program in Primary Care in Cantabria. The study aims to expand group sessions, enhancing urban–rural equity, and evaluate cost-effectiveness. Evidence shows that training health professionals in smoking cessation significantly improves their performance.

Methods

Four full-day in-person group behavioral counselling on quitting workshops were conducted between March 2025–March 2026. A professional guide was developed to support group organization and implementation. Urban centers are defined as municipalities >10,000 inhabitants; rural as < 10,000, with Cantabria’s rural population being highly dispersed.

Results

Seventy-six primary care professionals attended (58 nurses, 17 physicians, 1 physiotherapist; 51 urban, 25 rural); 36% were <45 years. Fifty-four groups were established in 17 centers, covering 45.8% of urban and 38.9% of rural centers, reaching 47.5% and 40.1% of their populations. Since September 2024, initiations grew from 13 to 25 in 2025, and 16 in Q1 2026, with 4 more planned in Q2. Rural centers increased from 3 to 6, raising coverage from 18.5% to 41.5%. Groups were led by nurses (74.4%) and physicians (25.6%) consistent with training attendance (76.3% vs 22.4%). A total of 529 patients participated (65.4% women, mean age 56.9 years; 76.6% urban). Group size grew from 5–8 to 14–20 participants. A 2025 survey found 41% had conducted at least one group, 13% planned but did not reach enrollment, and 23% had not planned any.

Conclusions

Between 2024 and 2026, centers’ capacity to organize groups increased, reflected in higher group-to-center ratios. Training boosted active centers and participants. Rural centers doubled their offerings, reducing urban–rural inequities. In just three months of 2026 participants nearly matched prior annual totals, demonstrating strong program demand.

Key messages

• Training of primary care physicians and nurses increases delivery of group smoking cessation counseling in routine practice.

• Training of professionals in group-based smoking cessation interventions increases coverage across centers, implementation and provider confidence.