Table 1 Exemplary contents of the ABC and 5A training with corresponding codes and labels according to the Behavior Change Technique (BCT) Taxonomy^a

1 Goals and planning

1.2 Problem solving

Prompt GPs to identify barriers preventing them from starting a conversation on smoking cessation during routine consultations and discuss potential solutions. For example how to advise patients with multiple unsuccessful quit attempts in their history, how to start a conversation on smoking cessation with patients having no smoking-related problems.

4 Shaping knowledge

4.1 Instruction how to perform the behaviour

Inform GPs verbally on how to provide brief advice to stop-smoking according to 5A/ABC with examples of different types of patients.

5 Natural consequences

5.1 Information about health consequences

Inform GPs verbally on health risks of smoking and benefits of smoking cessation, and on the role of GPs in reducing smoking prevalence on a population level.

5.6 Information about emotional consequences

Pointing out that the provision of brief-stop smoking advice aims at triggering a quit attempt rather than long-term abstinence in every smoker receiving such an advice. Lowering high or delusive expectation should lead to a reduction of frustration, and thus increase self-efficacy.

Only ABC training: Provide information on how application of the ABC method to deliver brief-stop smoking advice (without discussing patients’ motivation to quit) can reduce stress and frustration in daily GP routine, and thus increase satisfaction.

6 Comparison of behaviour

6.1 Demonstration of the behaviour

Demonstrate to GPs how to raise the issue of smoking cessation with patients indirectly via pictures of exemplary patient-physician conversations.

6.2 Social comparison

Providing information on the proportion of smokers in Germany who were offered GP advice on quitting by their GP, thus they can compare with their own performance.

6.3 Information about others’ approval

Telling GPs that smoking patients will appreciate a conversation on smoking cessation including the provision of support/assistance rather than a conversation with criticism or reproaches causing feelings of guilt in patients.

7 Associations

7.1 Prompts and cues

Provision of handouts for GP practice rooms to remind them of delivering brief stop-smoking advice to all smoking patients: including: the 5A/ABC method, behaviour change techniques for patients (e.g. setting a quit day), the Fagerström Test for Cigarette Dependence^b, information on evidence-based smoking-cessation therapy, contact information: smokers’ telephone helpline, regional group-based smoking cessation programs).

8 Repetition and substitution

8.2 Behaviour substitution

ABC: Suggest that GPs should not ask for patients’ motivation to stop smoking and provide their assistance instead to every smoking patient regardless of motivational status.

5A/ABC: Suggest that GPs provide stop smoking support as a brief or very brief conversation on smoking cessation rather than as a time consuming and exhausting discussion.

9 Comparison of outcomes

9.1 Credible source

Presentation of evidence-based data (e.g., data from Cochrane reviews) on the importance and effectiveness of brief GP advice to stop-smoking.

11 Regulation

11.2 Reduce negative emotions

Advise GPs how to reduce frustration during stop smoking conversations (e.g., through realistic goal setting: aiming to trigger a quit attempt rather than long-term abstinence in smoking patients).

13 Identity

13.2 Framing/reframing

Cognitive structuring: Suggest that medical advice on quit smoking must not necessarily be time consuming and exhausting (which are frequently reported barriers preventing GPs from raising a stop-smoking conversation).

1 Goals and planning

1.1 Goal setting (behaviour)

GPs are encouraged to apply all the steps of ABC/5A during the role play and therefore change their familiar patterns of behaviour during conversations on smoking cessation.

1.2 Problem solving

Discussions during role plays: prompt GPs to identify barriers preventing them from applying a specific step of 5A or ABC (“Which steps of 5A or ABC could you (not) apply during the role play, and why or why not?” “What could have helped/could be changed during in this situation?”).

1.5 Review behaviour goal(s)

Examine how well a GP’s performance during role play corresponds to agreed goals (e.g., applying all steps of the 5A/ABC method, or providing brief advice on quitting to the patient without reproaches or criticism); and consider a modification of a behavioural goal, e.g. through realistic goal setting: aiming to trigger a quit attempt rather than being responsible for the quit attempt’s success.

1.6 Discrepancy between current behaviour and goal

Trigger a quit attempt rather than long-term abstinence in smoking patients;

Trainer and peers point out and discuss which steps of 5A or ABC had not been applied during role play.

2 Feedback and monitoring

2.2 Feedback on behaviour

2.7 Feedback on outcomes of behaviour

Peers and trainers provide moderated feedback on GP’s behaviour/ performance and on observed outcomes (reactions) of patient (actor) during role plays.

3 Social support

3.2 practical support

3.3 emotional support

Peers and trainers provide practical and emotional support during role plays: e.g., advise on how to cope with a specific patient reaction.

4 Shaping knowledge

4.1 Instruction how to perform the behaviour

Repeated instructions (verbal) are provided by the trainers prior to the role plays: how to provide brief advice to stop-smoking according to 5A/ABC.

5 Natural consequences

5.4 Monitoring of emotional consequences

GPs are encouraged to reflect and reveal their feelings during active role play.

6 Comparison of behaviour

6.1 Demonstration of the behaviour

Provision of role plays with moderated feedback to practice the delivery of brief stop-smoking advice according to 5A/ABC.

6.2 Social comparison

GPs are encouraged to observe the performance of colleagues during role play allowing comparisons with their own performance during role play but also during past routine practice consultation.

6.3 Information about others’ approval

Peers and trainers provide feedback on the performance of the GP who participates in the role play.

8 Repetition and substitution

8.1 Behavioural practice/rehearsal

Provision of role plays with moderated feedback to practice the delivery of brief stop-smoking advice according to 5A/ABC.

8.2 Behaviour substitution

Trainer and peers suggest alternative reactions/sentences during role plays corresponding to the 5A/ABC method (e.g., ABC: providing assistance with attempt to quit rather than discussing patients’ motivation to quit smoking).

9 Comparison of outcomes

9.1 Credible source

GP peer trainer reports on own positive experiences but also on challenges with the provision of brief stop-smoking advice according to either the 5A or ABC method.

13 Identity

13.2 Framing/reframing

Providing measurements on the exact duration (minutes) of role-play in order to demonstrate that the provision of brief advice on quit smoking must not necessarily be time consuming, which is a frequently reported barrier preventing GPs from raising a stop-smoking conversation.

1 Goals and planning

1.1 Goal setting (behaviour)

Prompt GPs to set a self-defined goal for the next working day regarding the provision of brief stop-smoking advice with the so-called “Monday-Question”: “What would you change/ do differently next Monday in practice?”.

9 Comparison of outcomes

9.2 Pros and cons

Encouraging GPs to reflect the advantages and disadvantages of providing brief stop-smoking advice (more often) to their smoking patients.

13 Identity

13.3 Incompatible beliefs

Drawing attention to discrepancies between GPs’ current or past performance regarding the provision of advice to quit smoking and his or her self-image as a health consultant.

15 Self-belief

15.3 Focus on past success

Encourage GPs to reflect strategies which helped them in the past to have a successful conversation on smoking cessation with a patient.