The role of motivation in interventions aiming to help people stop smoking among patients

Worldwide, more than one thousand million people smoke tobacco. The trends have been on the decline in industrialized countries but it is on the rise in evolving countries and among women. According to WHO, the use of tobacco leads to about six million deaths yearly in the globe and most of them are premature. Additionally, about 600,000 other deaths occur due to effects that occur among second-hand smokers (Islami, Stoklosa, Drope, & Jemal, 2015). Smoking is linked to disability, ill-health, death from chronic non-communicable diseases, and an increase to risk of deaths from communicable diseases. There exist evidence that people who have tried quitting by reducing the sticks of cigarettes smoked abruptly with no earlier reduction, result to comparable quit rates (Ussher, Kakar, Hajek & West, 2016).

Therefore, it is recommended that there should be a combination of pharmacotherapy and behavioral support that is fully characterized by motivation of the smokers. Literature review Reasons for smoking There are various reasons why people chose to smoke. First smoking is addictive. In the cigarette and other tobacco forms, nicotine is present and it is one of the most addictive substances. Thereafter, Smoking also become a part of one’s daily routine. Emotions can lead people to smoking if that is the only means they have learned to use to cope with post-traumatic stress symptoms, stress, or any negative moods they are faced with in their daily life (European Network for Smoking Prevention, 2007). Smoking act as a coping mechanism to healing these anxieties and stress.

Most people who self-medicate rather than seeking expert help end up smoking. Social acceptance of smoking has led to an increase in the number of smokers. Peer pressure has seen more youths turning into smokers. Youths engage in smoking due to the influence of their peer as they desire to bond with them. The youths end up smoking to not feel left out among their peers or be seen as “uncool”. Important to note, this is how most teenagers start smoking. Effects of smoking Increased deaths In the US, smoking is the leading cause of preventable deaths. Through smoking, an individual’s overall health diminishes, and thus they are most likely to use more money in the health care costs and utilization, and they will also stay absent from work longer.

Cardiovascular diseases Smokers are at higher risk of heart and blood vessel diseases. Smoking leads to coronary heart diseases and stroke which are the main causes of deaths among people in the US. Notably, smokers who use less than 5 cigarettes in a day also experience the early signs of cardiovascular diseases. Blood vessels are damaged through smoking and they can thus thicken and therefore growing narrower (Papathanasiou, Mamali Papafloratos & Zerva, 2014). Smoking among cancer patients and survivors increases their risk of deaths and other diseases (Onor et al. One of every three cancer deaths in the US would be avoided if nobody in the US smoked. Other health risks Smoking negatively affects all parts of the human body and thus the overall health of the individual.

Among women, smoking lowers the probability of a woman becoming pregnant and it also affects the health of the baby before and after their birth. Due to smoking there are increased chances of ectopic pregnancy, delivery before term, stillbirth, low birth weight, sudden infant death syndrome (SIDs), and orofacial clefts among the newborns (CDC, 2017). For instance it leads to a reduced immune function, and inflammation in the body Smoking also leads to rheumatoid arthritis. Treatment for smoking cessation Dependence on nicotine calls for medical treatment like all other chronic diseases or drug-dependence disorders. Before the initiation of treatment, the mental health status, physical health status, motivation to quit smoking environmental factors, and co-morbidity should be assessed. The clients should be told of the benefits of quitting smoking and the withdrawal symptoms that come with quitting.

Additionally, together with the client, a treatment strategy suitable for the individual patients should then be developed. The enhancement of motivation is key for the whole treatment process of the tobacco addicts because it increases their enthusiasm, increases their sense of purpose, and their will to quit the habit (Roberts, Kerr & Smith, 2013). Additionally, the interventions are mainly geared towards a maximization of the skills and self-regulatory capacity of the patient such a strategies they can put in place to lower their exposure to smoking cues and other adjuvant activities like advise on social support from family or among members in a group, and pharmacotherapy. The clients can try replacement of smoking with other distractive behaviors. The smoker can try and distract themselves and get their hands busy.

They can look into new hobbies, exercising, sipping on water, or even chewing gum whenever they get the urge to smoke. Acknowledge that a problem exist 2. Identify the negative behavior that requires change 3. List down the pros and cons of changing the behavior like smoking in this case. Make the decision to change (WHO, 2001) 5. Identify your specific stage of change 6. Through patient centered approach, the needs of motivations of the client for change will be enhanced by looking into doubt to their ability to adopt positive behavior resolutions they can take to adopt and sustain a positive behavior (Roberts, Kerr & Smith, 2013). The counselling sessions are conducted weekly and they run for at least four weeks after the date they decide to quit and it is usually done alongside pharmacotherapy.

Studies have shown that sessions that are longer and multiple are more effective. In the session, advice can be offered on how they can reduce the number of cigarette’s before they can eventually stop. • Giving self-help materials to the clients Self-help materials refers to structure programs and manuals that the clients use with no help from support groups, trained counselors, or nay health professional. Through the group support, they offer peer support and individual patients get to learn behavioral techniques. In addition to the advice and information, pharmacotherapy is used. Currently, the effectiveness of groups counselling over individual counselling is unclear (Roberts, Kerr & Smith, 2013). However, individuals who attend group behavioral program have double chances of quitting in comparison to individuals who just obtain self-help material without any individual or group counseling.

• Brief advice To promote cessation, the health care profession needs to give brief advice to clients. • Use of new technologies With technological advancements like easier access to internet and use of smart phones other interventions have come up. Through use of text messages such as txt2Quit these motivational messages have seen the success in cessation in the UK and the US. Use of mobile phones to motivate and support stopping smoking has shown effectiveness even through there is a variance. The information, messages and advice sent out needs to be evidence-based. Pharmacotherapy Pharmacological treatment should aim at reducing or preventing the development of symptoms of withdrawal in the client and block the positive reinforcement effect that is brought about by nicotine.

Observations were made that use of the drug reduce d the cravings the smokers had for cigarettes (Jiloha, 2014). It has a stimulant effect due to the fact that it is a beta-phenylethylamine. it acts by preferentially blocking dopamine and norepinephrine in the nucleus and mesolimbic system and it has antagonistic of the nicotinic receptors. • Nortriptyline The drug is a tricyclic antidepressant and it has been proven to be effective for smokers hoping to quit smoking. The drug is a second line treatment drug in the treatment of smoking cessation. • Varenicline Varenicline is a cyticine analogue that has benefit on cessation of smoking. The drug has selective and high activity for receptors, specifically alfa4-beta2. The dug is partly agonist in this specific receptor in vivo and it results to lesser responses than those caused by nicotine and at the same time it causes blockage of any nicotine that a smoker is likely to add to the system.

The drug also results to central nervous mesolimbic system, neuronal method that govern strengthening and the recompense that is felt when one smokes (Jiloha, 2014). The drug helps in the maintenance of middle levels of dopamine release and thus lower the withdrawal symptoms and cravings that are experienced by smokers during abstinence. 7mg/day. The drug cannot be used in acute stopping as it blocks the nicotine effects and brings out the withdrawals. • Naltrexone The drug is a long acting opioid antagonist form (Jiloha, 2014). The drug is used in stopping smoking because positive effects of nicotine and performance enhancing effects may be opioid mediated. Target groups for prevention of smoking Various age groups and subsets of the population are at more risk than others when it comes to smoking and thus are often the major target in smoking interventions.

It results to improved health benefits in all smokers despite their ages even though they had or did not have smoking-related diseases. For instance, former smokers get to live longer than continuing smokers (WHO, 2001). Quitting smoking reduces cardiovascular risk in just the first year when they cease smoking, the risk of developing a congenital attack decrease abruptly. Additionally, within the second to fifth year, the risk of developing a stroke may go down to almost similar levels as in no-smokers. Stopping smoking leads to a decrease in mortality rate that results from the various health risks that develop as a result of smoking. The control group will receive no motivation just the ordinal pharmacotherapy and they will be given normal counseling on effects of smoking, statistics.

The intervention group will receive both the pharmacotherapy and behavior modification therapy characterized by group and individuals counselling where motivation will be a key element. The two groups will then be monitored over a period of time to look at the outcomes that will occur and are as a result of the motivation and behavior modification but not due to any other reason (Kirk, 2009). The study site will be Mayo Clinic and all respondents will be either current or former clients in the hospital all in the smoking cessation program. 2 Selection, sampling and recruitment During selection of respondents, caution will be taken to ensure that the selected clients will give pertinent and true information on the motivation and the less reliable respondents will be avoided.

They will be an equal gender representation informed of the 3. 3 Ethical consideration Written consent will be sought from the clients that will be recruited to participate in the study. There will be two copies of consent forms presented to the client, they will information on the researcher, the research, the methods of data collection, the period and it will be read out to them in a subject they will understand. The researcher walk then sign the consent form and the participant as well. The researcher will then keep one copy of the consent and give the other to the subject (Fouka & Mantzorou, 2011). 5 General description of data analysis Qualitative and quantitative data analysis will be used to explain why there will a difference among the behavior of the subjects.

The qualitative data will be done through the interviews and key information interviews. Computer based data analysis and management will be used to aid in the qualitative analysis by coding the data first 4. Ethical considerations The research will only be used to answer the specific questions of the research. The methods of assessment used will be well related specifically to the research question (Kamat, 2006). Confidentiality and anonymity will be integral throughout the research. The consent, participation, and study results will all be kept confidentially. Additionally, the identity of the subjects will be unknown even to the researcher. The study and results of the study will be all kept confidential until the individual responsible for the research releases this information to the general public (Kamat, 2006).

Moreover, all subjects involved in the study will be required not to disclose the preliminary findings to any entities outside the study since it is unethical. Example, the events the subjects experienced during the program intervention. The data will then be interpreted where attempts will be made to put the information collected in their respective perspectives, example comparison of the pre and post interview, measurements of reaching the goal a description of experience, strengths and also the weaknesses. Additionally, the recommendations by the subjects’ will be taken into consideration (Peersman, 2014). The recommendations and conclusions will be noted down in a report and interpretations will be given to justify the recommendations and conclusions. A report will then be provided on the findings, recommendations and conclusions.

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