Introduction:
Evidence-based interventions to counsel tobacco users have been validated and successfully implemented in a multitude of clinical, community, educational, and work-place settings in the United States. In FYROM, before such a program can be systematically introduced and evaluated, formative research can identify important cultural and societal factors to guide in the program’s adaptation and implementation.

Material and Methods:
Qualitative research is a reliable and valid method to obtain information that is contextual and subjective. Over three weeks in November 2016, five trained research assistants conducted 39 in-depth, qualitative interviews with patients and health providers from pulmonary clinics within Skopje, FYROM, lasting 52 minutes on average. Interviews were recorded, transcribed translated into English, coded, and thematically analyzed.

Results:
Data reveal salient issues to the adaptation of a tobacco counseling program. Respondents had limited information about pharmacological therapies and their availability in FYROM. They noted a lack of public education about the risks associated with tobacco use and they perceived current outreach efforts as being ineffectual. There was a lack of critical attention toward the needs of the elderly or those considered to be severly addicted. Health providers noted the need for more one-on-one time with patients to counsel them about tobacco use.

Conclusions:
Culturally competent approaches to program design are an effective means of applying evidence-based modalities in new settings. Qualitative research is an essential component of program adaptation within the core elements of an intervention and provides opportunity for collaborative decisions regarding content and delivery within a new socio-cultural context.

Funding:
Pfizer Independent Grants for Learning and Change