Table 3.

Adapting Very Brief Advice on Smoking to your context

Intervention	Rationale	Considerations
Establish smoking status (ASK): “Do you smoke or use a waterpipe?”	Knowledge of smoking status is a prerequisite to any intervention	How will smoking status be recorded and how will you ensure that smoking status is recorded for all patients?
Advise that the best thing that the patient can do for their current and future health is to stop smoking (ADVISE) “Smoking tobacco leads to lung disease, cancers, heart disease and an early death. Stopping smoking is the single most important thing that you can do to improve your health.”	In some countries, knowledge about the harmful effects of smoking is high and so there is no need to advise smokers that smoking is harmful. Additionally, a meta-analysis revealed that offering advice without the offer of support did not prompt quit attempts. Where cessation services (face-to-face or quitlines) you can simply advise on the best way of quitting: “The best way of quitting is with a combination of behavioural support and medication. We have a local, friendly stop smoking service who are experts in this and I can refer you if you’d like?”	Does this element need to include more information on the harmful effects of smoking and the benefits of cessation? Are resources needed to supplement the advice? The advice will be dependent upon what support is available
Act on patients' response to advice (ACT) by either: (a) facilitating referral to cessation services, or alternative support (e.g., prescribing or referring to a pharmacy or doctor with appropriate recommendations); (b) making a note in their medical records that advice has been delivered if they do not want to quit	Behavioural support (from a trained specialist practitioner or primary care professional) is the most effective method of supporting a quit attempt, but quit lines or self-help materials can be used. Recording that advice has been delivered is a prompt to health professionals that they need to deliver it again at the next appropriate contact with the patient	If referral for support is not available, can support be offered within your practice? What medications are available? Are written support materials or other resources (e.g., websites) available?