How To Motivate Someone To Quit Smoking | Motivational Intervention for Smoking Cessation

Enhancing motivation to quit smoking

Motivational Intervention

For patients who are not ready mentally to make a quit attempt for smoking, health care provider should apply motivational intervention to motivate and inspire patient to quit smoking initially. They are not desired or willingly to stop smoking may due to some reasons, such as lacking of information and facts regarding the harmful effects of tobacco, unaware of financial impact. Besides, they may also have fear of failure or concerns about quitting, as well as the experience of being demoralized because of previous relapse. Hence, motivational intervention should be acquired to educate and reassure these patients towards the first step of stop smoking.

Motivation is a dynamic process. It is multidimensional, fluctuating and may be defined as the probability that a person will enter into, continue and adhere to a specific change strategy. It is absolutely the first key to success.

The 5R Strategies applied in motivational intervention are "Relevance", "Risks", "Rewards", "Roadblocks" and "Repetition". It is advised that health care provider to apply the key principles and strategies in order to efficiently make the 'program' a success.

Relevance
Relevance would simply means that explaining or informing the patients regarding their personal relevance of smoking effect to their life, as specific as possible to persuade them. It has the greatest impact if it is most relevant to patient's disease status, health risk, family or social environment. For instance, for patients having cardiovascular disease that would be seriously affected by smoking, having children exposed to danger of second hand smoke, and financial problems.

Risks
Health care provider should ask the patient to identify potential adverse consequences of smoking which are most relevant to them. It must be emphasized to patient that the use of other form of tobacco or smoking low tar or nicotine content does not eliminate the risk.
The example for acute risks would be suffering of shortness of breath, reduced stamina, exacerbation of asthma, impotence and infertility.
Long term risks include increase frequency and chances of heart attack and strokes, high risk of contracting lung cancers, exaggerating COPD (Chronic Obstructive Pulmonary Disease).
Environmental risk would be posing health danger to family members, such as increasing risk of lung cancer and respirator infection.

Rewards
Rewards would be the opposite of Risks. Ask the patient to identify the potential benifit if he or she success in quit smoking, and highlight those most relevant to patient. Examples are as follows
Improved health condition, lower risk of cardiovascular disease
Improved sense of smell and taste
Save money
Healthier lifestyle to self as well as family
Feel better physically and mentally

Roadblocks
Roadblocks refer to the potential barriers or predicament that impede or deter the process to quit smoking. Typical barriers are withdrawal symptoms, weight gain, lack of support, addiction to enjoyment of tobacco, and depression.

Repetition
Repetition means expose the patient repeatedly toward the motivational intervention and the awareness every time patient visiting the clinic. Patient should know that many of the successful quitters does not make it at only first few attempts.

Motivational Interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence, is also a form of guidance to elicit and strengthen motivation and inspiration to make a change. (Miller & Rollnick)

The Spirit of Motivational Interviewing
Through this approach, health care provider must realise that the motivation to change is elicited from the client and it is the client's task to resolve his/her ambivalence, instead of the counselor's articulation. One must know that direct persuasion is not an effective method for resolving the problem.

The counselling style is generally quiet and eliciting in the direction of helping the client to examine and resolve ambivalence by self. Thus, the therapeutic relationship between the counselor and patient is more like a partnership or companionship than expert/recipient roles.

Principles of Motivational Interviewing
The 5 key principles of motivational interviewing would be "READS"
R - Roll with resistance
E - Express empathy
A - Avoid argumentation
D - Develop discrepancy
S - Support self-efficacy

The principles should be applied appropriately throughout the interaction to patients depends on their personality and characteristics. It is not necessarily be applied in any particular order.

Roll with resistance
Resistance is the patient's denial to change and may take several forms: Negating, arguing or challenging, interrupting, ignoring, blaming, excusing and minimizing. Hence, when facing these patients we do not have to oppose them directly but instead rolling or flowing with it as direct confrontation may only create additional barriers leading to more difficult condition. A person's resistance is expected and it would be more effective if the reason behind the resistance is understood and discovered.

It is also be reminded that to avoid direct argument with the parents if have different opinion or false belief towards smoking. Instead, use listening skill to diffuse or prevent some of their instinctive defensiveness. Also, try to encourage the patients come up their own solution rather than forcing suggestion on them. This approach will help them feel empowered rather than attacked.


Reflective Listening
Reflective listening is a way of showing empathy to patients, making them feel their thought are being given attention and have us thought from their perspective. By this, you have to listen to patients what they are saying or what they are trying to say, even if you do not agree with their views, and then reply back to them by paraphrasing or summarizing their opinions.

Example of reflective listening (specific)
"It sounds like you don't want to quit smoking at this time"
Examples of reflective listening (generic)
"It sounds like..."
"What I hear you saying..."
"It seems as if..."
"So on the one hand it sounds like..., and yet on the other hand..."
"I get the sense that..."
"It feel as though..."


Expressing empathy
Since building up a strong rapport with the patients is a crucial way in motivational interviewing, one has to remind the importance of showing empathy to patients, understand their view and has their points and views from their perspective and thoughts. As mentioned above, use your reflective listening skill to build up patients' self esteem, and then strengthen and emphasize what they are trying to express with judging, criticizing or blaming to help forming a mutual relationship.

Avoid argumentation
Direct argument won't help but instead aggravate the interviewing atmosphere. One must take note that patients' resistance to change will increase as there is direct argument or confrontation occur. Also, increase in patients' resistance showing that interviewer's strategy has to be changed.

Developing Discrepancy
The purpose of this approach to raise the awareness of the patients so they perceive and understand the need to alter the behaviour. The discrepancy means how their current behaviour differ from their setting goals which inspire and motivate them to make a change.

To develop the discrepancy, one has to encourage patients setting their achievable goal themselves by emphasizing the pros and potential advantage if they successful in quit smoking, such as cost saving and health concern, on the other hand the cons of keeping the bad habit (health danger expose to family members). As the awareness of a discontent with costs of one's present course of beavhiours especially when behaviour is seen as conflicting to one's health, success or family happiness, discrepancy is more likely be triggered and then is higher chance to change.

Besides exploring the consequences or potential consequences of the patient's current behavours, one has to try create, emphasize and amplify in the patient's mind a discrepancy between their current behaviour and their set goals.

Support self-efficacy
Self-efficacy is one's belief or confidence in their ability to carry out a target behavioural successfully. Hence, it is important to set a reachable and accessible target for patient to achieve, for example, reducing the number of cigarette slowly (tapering down) instead of asking to totally free from smoking in initial plan.

Also, elicit-provide concept help one to elicit information from the patients to have better understanding about their attitudes, belief, values and readiness to change.

Examples below are the eliciting statement to support self-efficacy
"It seems you have been working hard to quit smoking. That is different from before. How have you been able to do that?"
"Last you were not sure be able to go one day without smoke, how were you able to refrain yourself from smoking the entire past week?"
"So even though you have not been abstinent everyday this past week, you manage to cut down your number of cigarette significantly. How were you able to do that?"

At last, it is reminded to follow-up with a question about how patients feel about changes they made.
"How do you feel the changes you made?"

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