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Help Smokers Think About Quitting

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Motivational Interviewing

The topic of this lesson is motivational interviewing, a technique you can use to lead smokers down the road to kicking their habit.

If you want to influence someone to stop smoking, the first step is to help them realize that they would rather not be a smoker. Many doctors in the USA and Canada use motivational interviewing to get patients talking and thinking about quitting. You can too.

Listen and Ask Questions

As you speak with smokers, listen for the opportunity to discuss their habit. Talk in a gentle way that does not make them feel bad. Ask questions and respond with encouraging words.

Example of a Motivational Interview

In the following example, a young mother has taken her baby boy to the doctor because he has an ear infection. The baby has had several ear infections. The doctor knows the young mother smokes and gently asks some questions.

Doctor
I see you marked the “Yes” box in our health questionnaire that asks if you smoke. Can you tell me more about that?
Mother
Yes, I smoke. But I try not to smoke around my baby. I have smoked for ten years, except when I was pregnant. I work full time and have a lot of stress. Smoking helps me relax.
Doctor
You try not to smoke around your son. Why did you make that decision?
Mother
I know cigarette smoke is not good for him and that my smoking might be causing my boy to be sick and have ear infections. But I know other parents who smoke, and their kids do not get sick and have ear infections.
Doctor
So you are worried that your smoking might make your son sick. But you are not sure if it causing his ear problems.
Mother
Yes, that is correct. I have thought about quitting, but I just do not see how it is possible right now.
Doctor
What made you decide to quit smoking when you were pregnant?
Mother
My baby was inside me and we were sharing every thing. I could not live with myself if my smoking caused him to die before he was born or to be born with health problems.
Doctor
I understand. Now you feel it is too difficult to even try to quit smoking?
Mother
Yes. Exactly.
Doctor
How were you successful when you quit before?
Mother
I just did it. I was scared that my smoking might cause my baby to be born dead or born with defects. I could not take that risk.
Doctor
The risks were so frightening that thinking about them helped you stop. Do you have any of those feelings now?
Mother
Now we are two separate people so the risk of health problems is lower. But I try not to smoke near my baby and I do not let other people smoke near him.
Doctor
You are doing the best you can do. But it sounds like part of you wants to quit.
Mother
Yes, I know I need to quit. Every New Year I promise myself that I will quit smoking. But something happens and I do not quit.
Doctor
I understand. On your list of priorities, stopping smoking is not quite at the top.
Mother
Yes, that is right.
Doctor
If you really wanted to quit, on a scale of one to ten, with one being you do not think you can do it, and ten being you are sure you can quit, where do you think you are right now?
Mother
Probably about five. I have quit smoking before so I think I could do it again. But it would be really difficult. It is not the same as when I was pregnant. I do not have the same scary risks to think about.
Doctor
What made you choose five on the scale instead of two or three?
Mother
I know smoking is bad for me and I do not want my baby boy to grow up using tobacco. I know I need to quit before he gets old enough to know what I am doing. I just do not know if I can.
Doctor
It sounds like you have a lot of reasons why you would like to quit. You have been successful in the past, but right now you do not feel strong enough to do it. Where do you think we should go from here?
Mother
I do not know. I would like some help. But I do not know what kind of help I need.
Doctor
If you are interested, I am willing to assist. There are several new options that can help people be more successful with quitting. There are different medications you can try.
Mother
I do not like medicines.
Doctor
OK. Then there are classes you can take and support groups you can attend. You would be with other people going through the quitting process. Sometimes having support is a big part of success, especially for people like you who depend on smoking to relieve stress.
Mother
That sounds nice, but I do not think I have time.
Doctor
A support group might take a lot of your time and not fit into your busy life. There are some other things that could work better for you. I am going to give you a prescription for antibiotics that will fix your boy’s ear infection. But if you would like to make another appointment, we could talk about those other options.
Mother
That would be great. I would like that.

Note: This interview was adapted from a video produced by University of Florida Department of Psychiatry. Funded by Flight Attendant Medical Research Institute Grant #63504.

The Doctor’s Skill

Notice that as the doctor visited, he did several things to make his conversation successful:

  • He focused on the mother’s views.
  • He gave the mother opportunity to think about her situation.
  • He prompted the young mother to discuss several reasons why she would like to make a change.
  • He did not scold or tell the mother what to do.
  • He helped the young mother talk about her own reasons for wanting to quit smoking.
  • He accepted and respected the mother’s thoughts, even though some of them were wrong.
  • He recognized that the young mother already knew the dangers of smoking.
  • He understood the mother’s struggle and offered to help find a solution.

Motivational interviewing is a powerful and effective tool. Your conversation can lead smokers to take steps to kicking their habit.

Share with Friends

As a doctor or health care worker, you are in a unique position to help change the culture of smoking, which is the biggest cause of preventable death in China. Look for opportunities to use your leadership skills to gently guide your patients, family and friends to a smoke-free future. I also encourage you to share our Leadership Club with your friends and colleagues and invite them to join. Together we can make a difference.

By Marlin Gimbel
Leadership Club Program Director

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