The Stages of ChangeMotivational 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
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:
|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|
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.
- Persistent efforts
- Repeated contacts
- Helping the smoker take the next step
- Bolster self-efficacy and motivation
- Match strategy to patient stage 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
- Support self-efficacy
- Promote autonomy
- Be applied when clients are unready, unwilling, or unable to quit smoking
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
- Symptoms of withdrawal
- Weight gain
- Friends or family who smoke
- Being afraid of failure
- Lack of support
- 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.