Results (
Thai) 2:
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We sought to enrol a representative sample of smokers, not just
those seeking help to stop smoking. Participant characteristics
were as follows: 55.7% were women, the mean (SD) age was 41.3
(11.7) years, 96.2% were white, 49.3% had been educated up to age
16 years only, 43.3% were from non-manual occupational groups.
The participants smoked a mean (SD) of 19.5 (11.4) cigarettes per
day with a mean (SD) Fagerstrom Test for Nicotine Dependence
(FTND) of 4.2 (2.3), which means that these smokers were slightly less dependent than typical enrolees in smoking cessation treatment.
At enrolment, 1131 (45.8%) were in precontemplation, 922
(37.3%) were in contemplation, 289 (11.7%) were in preparation, and
129 (5.2%) were not staged because of missing or inconsistent
responses. These characteristics were well-balanced across the
arms (Table 1).
The first hypothesis tested in this study is that TTM-based
interventions were more effective than standard interventions
when assessed by change in stage. Stage was defined according to
the algorithm described by Diclemente et al. (1991). A positive
movement in stage was classified as a movement closer to quitting
smoking and we calculated the proportion of participants making
a positive stage movement. Secondly, a change score was calculated,
giving each stage a number from 1 (precontemplation) to 5
(maintenance) and taking the difference between the starting and
final stage. Those with missing starting or finishing stage were
assigned the mean change score.
The second hypothesis tested in this study is that stage-matched
materials would be more effective than stage-mismatched materials.
Stage-appropriate materials engage the processes of change
needed to advance to the next stage from the current stage,
whereas stage-inappropriate materials encourage use of processes
appropriate for other stages but not the stage of the particular
respondent. Three of us independently coded the self-help programmes
for the control (Stopping Smoking Made Easier) and TTM
arms (The Pro-Change Programme for a Healthy Lifestyle). (The Quit
Guide to Stopping Smoking was not coded, because it is not a selfhelp
guide. It contains a description of commonly used technology
to help stop smoking, such as hypnotherapy, and summarises the
evidence of effectiveness. It does not advocate stopping smoking or
the use of any processes of change. The reminder cards were not
coded because they were not self-help programmes in the way that
the other two interventions were). The control intervention had
two sections – one on preparing to stop smoking, and one on
stopping. The Pro-Change manual was divided into chapters, one
for each stage. On each occasion the self-help materials encouraged
readers to think or do something (e.g. write down the reasons you
want to stop smoking), we allocated each piece of advice or selfcompletion
exercise to one of the ten processes of change and
resolved disagreements by discussion. The processes of change and
the stages in which they should be used (Prochaska & Velicer, 1997)
are shown in Fig. 1. A brief definition of each process is given in
Table 2. The percentage of times each process was encouraged to be
used for each section or chapter is shown in Figs. 2 and 3. As can be
seen, consciousness raising was frequently engaged, which effectively
means encouraging people to think about the facts of
smoking, such as it is damaging their health. However, both
cessation manuals show some evidence that they were largely
stage appropriate. However, the Pro-Change manual explicitly
recognised people were not ready to stop smoking and implied
a long journey to get there. Stopping Smoking Made Easier assumed
people were ready to stop, revised the reasons to do so, and
encouraged immediate action (as evidenced by the high frequency
of encouraging self-liberation process use in the preparation
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