Introduction:
Tobacco cessation training programs are scare in Spanish speaking low-income countries. Based on a previous program developed in Spain, the Fruitful Study has adapted, implemented and evaluated the effectiveness of an online smoking cessation training program in three hospitals from Bolivia, Guatemala and Paraguay.

Material and Methods:
To describe the adaptation and the program fidelity of the Fruitful Study. Methods/design: Mixed methods study. To assess the adaptation process we registered the mismatches and conducted a focus group. To evaluate program coverage and fidelity we conducted a cross-sectional survey.

Results:
During the adaptation, the main mismatches were: language background and content information. Several aids were developed for making possible students’ enrollment including: access to computers; support from technicians due some studies had little experience in pursing online education (less qualitied and > 50 years/old) and; reminders for the correct implementation including (in person sessions, emails, and videos). 281 clinicians registered the program. The program coverage was higher in Bolivia, where 55.0% of clinicians enrolled the course, compared with 29.3% in Guatemala, and 25.4% in Paraguay. Overall, 66.2% students completed the training. Fidelity of the curriculum plan reached the 64%.

Conclusions:
Program fidelity was similar to the obtained in high-income counties. However, to achieve a high program effectiveness online smoking cessation training programs addressed to these low-income countries should introduce adjusted tools and messages to improve its delivery including technician support, reminders for completing the course, and having a pdf version available for those students who prefer a hard copy.

Funding:
This study has been funded by Global Bridges Mayo Clinic (Pfizer Medical Group; GB-13520139: Development and Dissemination of a Tobacco Cessation Training Program for Healthcare Professionals in Spanish-speaking Countries). Moreover, CM and EF are also funded by the Spanish Government (Instituto de Salut Carlos III, grant PI15-00875) and the Catalan Government (Xarxa Catalana d’Hospitals sense fum, Agència de Salut Pública de Catalunya, contracte Nº 2015VAR171)