Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Fax to Assist - Module 3

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The Stages of Change

Motivational Strategies The 5 R’s for those Unready to Quit Overview of Module 3 In this module you will learn about:
  • Stages of Change
  • Motivational Strategies
  • The 5 R’s
1. Stages of Change

The process of quitting smoking can be conceptualized as progressing through a series of stages of change. Once individuals become dependent on nicotine, they seem to move and recycle through five stages on their way to achieving long-term abstinence from smoking. Each of the stages represents important tasks that the smokers need to accomplish in order to successfully change.

2. Five Stages of Change for Smoking Cessation:
Fax to Assist Module 3 the 5 Stages of Change
3. Stage of Change Tasks
Precontemplation Awareness, Concern, Hope, Confidence
Contemplation Risk-Reward Analysis & Solid Decision to Change
Preparation Commitment & Creating an Effective/Acceptable Plan
Action Adequate Implementation and Revising of Plan
Maintenance Integration of New Behavior into Lifestyle
4. Stages and Smoking Cessation The stages help to understand the temporal and motivational dimensions of smoking cessation. The following figures offer a illustrative view of the entire process

Figure 1 shows the factors related to stage movement. Figure 2 helps you to understand that it is not a linear process, but for most smokers, a cyclical one.

5. Figure 1. Theoretical and practical considerations related to movement through the Stages of Change.
Figure 1 - Stages of Change
6. Figure 2. Stages of Change Model
Figure 2 - Model Stages
7. Cyclical Model for Intervention Most smokers will recycle through multiple quit attempts and multiple interventions. However successful cessation occurs for large numbers of smokers over time.
Successful Recycling
Keys to successful recycling
  • Persistent efforts
  • Repeated contacts
  • Helping the smoker take the next step
  • Bolster self-efficacy and motivation
  • Match strategy to patient stage of change
8. Helping Smokers in Early Stages of Change

Motivating smokers who are not ready to quit is always a challenge. There are some new ways that have been developed to address smokers in Precontemplation, Contemplation, and Preparation Stages called Motivational Enhancement Strategies.

9. Motivational Strategies Motivational approaches focus on providing:
  • Appropriate empathy
  • Personalized feedback
  • Positive reinforcement
Motivational strategies can:
  • Support self-efficacy
  • Promote autonomy
  • Be applied when clients are unready, unwilling, or unable to quit smoking
10. Addressing Barriers to Quitting

Motivational strategies can be effective even if a client does not want to quit. Reasons for not quitting include: Misinformation, negative aspects of quitting (e.g., withdrawal), and prior unsuccessful attempts. Motivational strategies can help clients make more informed choices, help overcome barriers to quitting, and have greater confidence about future quit attempts. The 5 R's represent topics that are useful to address when helping smokers who are unready to quit move toward cessation.

The 5 R’s are: Relevance, Risks, Rewards, Roadblocks, and Repetition 11. Relevance Provide information that is relevant to the client’s situation, environment, and individual needs (e.g., health status, culture, and gender). When providing individualized information, ask the client to identify how quitting is relevant to them and their loved ones. Encourage the client to be as specific as possible. 12. Risks Ask the client to identify negative effects of tobacco use; help identify which consequences are most important for the client. Inform the client that smoking low-tar/low-nicotine cigarettes or using alternative forms of tobacco (e.g., smokeless tobacco or cigars) will not reduce potential consequences. Address acute, long-term, and environmental risks associated with smoking. 13. Rewards Ask the client to identify the benefits of quitting tobacco use, highlighting those most relevant for that individual. Possible rewards include:
  • Better health for individual and individual’s family
  • Improved sense of smell and taste
  • Money saved
  • Improved self-esteem
  • Being a good role model to children and family
14. Roadblocks Help the client identify any obstacles to quitting. Some common roadblocks are:
  • Symptoms of withdrawal
  • Weight gain
  • Friends or family who smoke
  • Being afraid of failure
  • Lack of support
Discuss treatment options (e.g., pharmacotherapy and problem-solving) to help overcome roadblocks. 15. Repetition Every time you have contact with a client who is smoking, you can address the 5 R’s. It can be reassuring and motivating to share that many smokers will make several quit attempts before successfully quitting. 16. Summary of the 5 R’s Relevance: Help the client identify why quitting is relevant. Risks: Encourage the client to verbalize possible negative outcomes of tobacco use. Rewards: Have the client verbalize possible benefits of quitting tobacco use. Roadblocks: Work with the client to identify obstacles to quitting. Repetition: It may take more than one motivational intervention to help clients move toward a quit attempt. 17. Making an Impact on the Smoker Keys to success
  • Match interventions to the client’s stage of change
  • For those less ready, i.e., in Precontemplation and Contemplation, address the 5 R’s.
  • For those more ready, i.e. in Preparation help the client develop a quit plan.
  • For those who have successfully quit, i.e. in Action or Maintenance, discuss how to prevent relapse.
  • Increase the pros of quitting and cons of continued smoking.
  • Bolster self-efficacy and motivation to change.
YOU HAVE FINISHED MODULE 3. Please CLICK HERE to proceed to MODULE 4, which covers: What your client will experience once contacted by the Maryland Quitline.