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Basic Concepts

homeLaunching QuitlinesBehavioral CounselingBasic Concepts

Basic Concepts for Changing Behaviors

Transtheoretical Model
In smoking cessation, a smoker needs to be motivated to change in a staged approach. There are specific processes and principles of change that can be applied during certain stages (pre-contemplation, contemplation, preparation, action, maintenance) during this change to progress through all these stages of change. Each stages could be treated by 5A (Ask, Assess, Advise, Assist, Arrange) and 5R (Relevance, Risk, Rewards, Roadblocks, Repetition).
  • Stage of pre-contemplation: education and public relations (Relevance, Risk, Rewards, Roadblocks, Repetition)
  • Stage of contemplation: transition of behavior via self-evaluation (Ask, Assess, Advise, Assist, Arrange)
  • Stage of preparation: set-up expectation of transition of behavior, acquisition of knowledge (Ask, Assess, Advise, Assist, Arrange)
  • Stage of action : action of healthy behaviors , educational strategy for prevention of relapse (Assess, Advise, Assist, Arrange)
  • Stage of maintenance: acquisition of skill and new healthy behaviors for prevention of relapse (Assess, Advise, Assist, Arrange)

Multiple-Session Interventions

Your protocol needs to reflect the evidence base on the number of sessions to run with a smoker. Evidence shows that three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone (a dose-response). One or two brief calls are less likely to provide a measurable benefit.

Proactive or reactive approach

Most existing Quitlines have employed both proactive and reactive elements. The overall evidence indicates that such Quitlines have the potential not only to provide effective assistance to those who seek it but also to increase quitting among tobacco users generally.
  • Proactive approach Proactive Quitlines may provide some form of immediate “reactive” assistance when a tobacco user first calls, but they also provide more comprehensive services through outbound (“proactive”) calls. The outbound service, which often entails multiple followup sessions, is typically scheduled by agreement with the smoker. Proactive personalized telephone counseling is reported to be effective among adults. In the proactive approach, the counselor initiates one or more calls to provide support in making a quit attempt or avoiding relapse. This is particularly useful with certain high risk populations, such as women who continue to smoke during pregnancy and do not attend any cessation program to quit smoking.
  • Reactive approach Reactive Quitlines, which respond to callers’ immediate requests for assistance but do not provide outbound counseling calls, have not been studied as widely as proactive Quitlines. Although there is some evidence of its effectiveness when compared with an intervention that provided callers with only self-help materials, this strategy has not been recommended by the various guidelines. Even though more studies are needed to assess the efficacy of reactive Quitlines, reactive Quitline setting may be also useful. In reactive approach, counselor behavior evoking quit motivation has been positively associated with therapeutic alliance and treatment engagement