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Ivey International Centre for Health Innovation

Beyond the patch: A person-centred approach to behaviour change for smoking cessation

  • Katie Shillington
  • |
  • Nov 13, 2018
Beyond the patch: A person-centred approach to behaviour change for smoking cessation

Picture this: it’s early October, the leaves are beginning to change colour, the sun is shining bright and you are sitting on the porch with your friend, both enjoying a cigarette – your favourite pastime. You look over at your friend, after exhaling a puff of smoke, knowing that one of you is going to die prematurely as a result of this pastime. It’s no surprise that smoking continues to be a hot topic in healthcare, as it is not only the leading cause of premature and preventable death in Canada, but worldwide. Tobacco smoke contains over 3,500 chemicals which puts smokers at risk for developing ischemic heart disease, cerebrovascular disease, lower respiratory infections, COPD, tuberculosis, and specific cancers. Smoking is also the only substance to exist that kills 50% of those who engage in the behaviour regularly.

Chronic diseases, such as the ones noted above, cost the Canadian healthcare system a significant amount of money, specifically, 55% of total direct and indirect healthcare costs. A tobacco-free society would prevent over 90% of deaths attributed to lung cancer, which would in turn reduce the amount that smoking costs the healthcare system dramatically. By implementing key elements from the World Health Organization Framework Convention on Tobacco Control (FCTC) and taking into consideration the financial costs to their implementation, researchers Asaria et al. (2007) concluded that 13.8 million tobacco-related deaths could be avoided. An intervention such as this would amount to less than $1.00 USD per person, which is fewer than the amount smoking currently costs the Canadian health system, at $16.2 billion per year.

Though the smoking rates in Canada have declined from 2015-2017, it’s difficult to claim the reason being smoking cessation interventions. It may be more accurate to attribute this decline to the fact that people who began smoking 30-50 years ago are either dying or experiencing smoking’s negative effects. Thus, the smoking-related costs to Canada’s healthcare system remain high. Over the years there have been a number of smoking cessation interventions attempting to curb the unhealthy addiction; these include: nicotine gum, patch, nasal spray, inhaler, lozenges and more recently – e-cigarettes. However, none have proven to be greatly effective, with the highest success rate being only six months of abstinence from smoking. 

A specific study noted evidence supporting the effectiveness of motivational interviewing (MI) as an intervention for smoking cessation, compared to brief advice giving. MI can be described as a process of assisting individuals in recognizing their negative health behaviours and asking open-ended questions such that individuals talk themselves into change based on their personal needs. Providing brief advice to quit smoking proved to be less successful than MI. This is likely because MI is a patient-centred intervention that helps smokers appreciate the value of change by exploring how they want to live their lives compared to how they are currently living. MI has been utilized in addiction research, as well as health-care professions and has been a successful approach to health-related behaviour change, specifically smoking-cessation. One particular study demonstrating its success, whereby they investigated the smoking behaviours of 40 individuals aged 19-25 years. Results concluded that individuals’ smoking behaviours decreased from pre- to post-intervention, including the number of cigarettes smoked per day and cigarette dependency. Unlike other smoking cessation interventions, this study revealed that MI demonstrated personal benefits for participants, including increased self-esteem and self-efficacy. In addition, 27.5% of participants remained smoke-free at the 12-month follow-up, which is significantly more successful than previous smoking cessation interventions. MI for smoking cessation has also been utilized worldwide, with notable success in Spain and Korea.

With evidence demonstrating its success, MI needs to be addressed at a system level, but how can we implement MI for smoking cessation in healthcare professions and to what extent? We turn to research done by Friedman et al. (2015) to address these concerns, where they applied MI in the field of oral health. Their research indicates that dentists likely ask patients to change/improve their oral health on a daily basis, but it’s important to note that they cannot take responsibility for patients’ oral health. To this end, health care providers should offer information, with permission, to their patients and work with them to achieve their optimal state of well-being. Morrow and Irwin (2014) note that it is important for health providers to resist the impulse to offer unwanted advice or information. Today it is common for a patient to go to their healthcare provider and explain their symptoms, to which the healthcare provider will provide them with general guidelines or strategies that have worked for the majority of the population in combatting the health concern. What MI attempts to break is the barrier between the healthcare expert and the patient, fostering a mutual partnership and allowing the physician and patient to work in collaboration, whereby they create a care plan tailored to the patient’s needs.

MI is an innovative and successful approach to smoking cessation. It has been utilized in a number of clinical, as well as individual settings with demonstrated effectiveness worldwide. If Canadian healthcare providers were trained in MI, the number of people who smoke would likely decrease, which in turn would save the healthcare system a significant amount of money. It is important to note that it would be feasibly impossible to train all health care providers from various disciplines and across Canada in MI, which is why we turn to successful interventions that have been done globally. A smoking cessation intervention done in Spain trained five family physicians within the Spanish Public Health Care System in two different health centres in Albacete, Spain. Similarly, an oral health MI intervention done in Eastern Trinidad trained dentists and dental nurses at the Armina District Health Facility through a one-day course (8 h) on MI skills for health professionals. The training included both hands-on and theoretical elements, with materials made available for self-study. Based on these global initiatives it may be more realistic to initially target a specific area in Canada, namely Newfoundland and Labrador, as it has one of the highest smoking rates in Canada. From there, it is suggested that healthcare providers are given training similar to those in the global smoking cessation interventions.

MI is a person-centred approach to behaviour change, which differs from previous unsuccessful smoking cessation interventions. MI aids individuals in taking control over and improving their health, with continued support from a healthcare provider. The success of this approach is two-fold as smokers would gain confidence and improve their health, while tobacco-related healthcare costs would decline. Although there have been a number of smoking cessation interventions over the years, none compare to the person-centred care that MI offers. So the question remains, would you rather pay for a short-term fix or gain confidence, self-efficacy and behaviour change skills tailored to your personal needs and values?   

Katie Shillington is practicum student working as a Student Research Analyst at the Ivey Centre for Health Innovation. She is in her fourth year pursuing a Bachelor of Health Sciences with an Honours Specialization in Health Promotion.