Thoughts, Feelings And Behaviours Of Clients Attending Five Stop Smoking Clinics In Malaysia


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Thoughts, Feelings And Behaviours Of Clients Attending Five Stop Smoking Clinics In Malaysia

  1. 1. Thoughts, Feelings and Behaviours of Clients Attending Five Stop-Smoking Clinics in Malaysia Wee Lei Hum Awang Bulgiba Robert West Malaysia Council for Tobacco Control Conference 2009 UKM, Medical Centre, Cheras 8 – 9 August, 2009
  2. 2. Outline <ul><li>Aims </li></ul><ul><li>Quit smoking in Malaysia </li></ul><ul><li>Methods </li></ul><ul><li>Brief on PRIME Theory </li></ul><ul><li>Results </li></ul><ul><li>Summary of findings </li></ul><ul><li>Implications of finding </li></ul><ul><li>Plan for future analysis </li></ul>
  3. 3. Aim of the Study <ul><li>To provide a better understanding of the processes involved in quitting smoking </li></ul><ul><ul><ul><li>Factors that led smokers to seek help to stop smoking </li></ul></ul></ul><ul><ul><ul><li>Smokers’ planning in making decisions to quit smoking with the clinic </li></ul></ul></ul><ul><ul><ul><li>Feelings about stopping smoking </li></ul></ul></ul><ul><ul><ul><li>Smokers’ self-identity </li></ul></ul></ul>
  4. 4. Quit Smoking Clinics <ul><li>294 clinics nationwide </li></ul><ul><li>Only 38% of smokers aware of quit smoking clinics </li></ul><ul><li>Awareness higher among: </li></ul><ul><ul><li>more educated </li></ul></ul><ul><ul><li>professionals & </li></ul></ul><ul><ul><li>younger smokers </li></ul></ul><ul><li>71% of current smokers had ever attempted to quit </li></ul><ul><ul><ul><ul><ul><li>(NHMS3) </li></ul></ul></ul></ul></ul>
  5. 5. Study Design and Samples <ul><li>Setting </li></ul><ul><ul><li>5 quit smoking clinics (Tanglin, Pantai, Jinjang, Kg.Pandan & Putrajaya Hospital) </li></ul></ul><ul><li>Study design </li></ul><ul><ul><li>Cross sectional study & part of prospective study </li></ul></ul><ul><li>Method of data collection </li></ul><ul><ul><li>Face-to-face interviews </li></ul></ul><ul><li>Participants </li></ul><ul><ul><li>All smokers attended QSC for 1 st time (June 2007 – May 2008) (N = 200) </li></ul></ul><ul><ul><li>Referred by a doctor, walk-in or call-in </li></ul></ul>
  6. 6. Summary of Topics Covered <ul><li>Background information </li></ul><ul><ul><li>personal particulars, smoking history, current smoking and health status </li></ul></ul><ul><li>Processes involved in smokers’ decisions to quit smoking </li></ul><ul><ul><li>Planning, tensions, triggers, confidence level and motivation </li></ul></ul><ul><li>The instruments used were prepared in two languages using the process of back translation </li></ul>
  7. 7. PRIME Theory (West,2006) <ul><li>Broad theory of motivation to understand how behaviour change occur in everyday life </li></ul><ul><li>Focus on the planning, tensions, triggers and moment </li></ul><ul><li>Every moment we pursue what we most wanted or needed at that time </li></ul><ul><li>Wants – anticipated pleasure or satisfaction of imagined outcome </li></ul><ul><li>Needs – anticipated relieve </li></ul>
  8. 8. PRIME Theory… 2 <ul><li>The decision to make a change in behaviour involve making a personal `rule’ </li></ul><ul><li>E.g. if a personal rule is `not to smoke’ and the feeling of not smoking is more beneficial, then the smoker will consciously takes steps to fulfill the rule when face with smoking cues, wants and needs to smoke </li></ul>
  9. 9. PRIME Theory … 3 <ul><li>PRIME Theory predicts that the nature of the not smoking rule may have major effects on the success of the quit attempts </li></ul><ul><li>If the smokers rule is `to try not to smoke’ the motivation in the smoker is expected not to be strong enough to prevent him from smoking in challenging situations </li></ul><ul><li>If the rule is that smoking is not permitted at all, then the boundaries of the rule are more clearly define </li></ul><ul><li>However, for the rule to be able to overcome consistent strong wants or needs to stop smoking, the smokers need to have `deep identity’ as a non-smoker </li></ul>
  10. 10. Samples N % Age group (Mean = 35, SD = 12) 15 - 24 years old 36 18.0 25 - 34 years old 78 39.0 35 - 44 years old 36 18.0 45 - 54 years old 33 16.5 55 years old and above 17 8.5 Sex Male 191 95.5 Female 9 4.5 Ethnic group Malay 129 64.5 Chinese 34 17.0 Indian 35 17.5 Others 2 1.0 N % Educational level Primary school 13 6.5 Secondary school 100 50.0 Tertiary 87 43.5 Occupation Professional, technical and business 91 45.5 Clerical, service and arm forces 46 23.0 Craft, plant and machinery and elementary 32 16.0 Retired, unemployed, housewife and student 31 15.5 Marital status Married 119 59.5 Single/Divorced/Widowed 81 40.5
  11. 11. Smoking History and Current Smoking N % Age at first smoke (Years) (Mean = 17, SD = 4, Median = 16) 10 years and below 5 2.5 11 – 15 years 78 39.0 16 – 20 years 95 47.5 21 years and above 22 11.0 Longest time without cigarettes (Mean=12, SD=36, Median = 1) 0 – 4 weeks 149 74.5 5 weeks and above 51 25.5 N % Household smokers No smoker 104 52.0 One smoker 49 24.5 Two smokers 25 12.5 3-6 smokers 22 11.0 Daily average amount spend, RM (Mean = RM7, SD = 4) Below RM 5 35 17.5 RM 5 – RM 10 140 70.0 RM 11 – RM 15 14 7.0 RM 16 and above 11 5.5
  12. 12. Smoking History and Current Smoking N % Fagestrom test score (Mean = 4, SD = 3, Median = 4) Low (0-3) 69 34.5 Moderate (4-5) 59 29.5 High (6-10) 72 36.0 Place where decision to quit was made At home 107 53.5 At a clinic or hospital 54 27.0 At work 21 10.5 Walking down the street 10 5.0 Somewhere else 8 4.0 Health problem Yes 64 32.0 N % Average cigarettes smoked per day (Mean=18, SD=11, Median = 15) Below 10 sticks 30 15.0 10 -15 sticks 72 36.0 16 – 20 sticks 66 33.0 21 sticks and above 32 16.0 Present method of quitting Abrupt 123 61.5 Gradually 77 38.5
  13. 14. What smokers were actively thinking when made decision to quit
  14. 15. Single Event that Finally Led Smokers to Quit
  15. 16. <ul><li>Table page 9 - paper </li></ul>Tension and trigger in smokers who had not been seriously thinking to quit smoking before they heard about the clinic
  16. 17. Tension and trigger in smokers who had been seriously thinking to quit smoking before they heard about the clinic
  17. 27. Summary of Finding (1) <ul><li>Younger smokers </li></ul><ul><li>Professional group </li></ul><ul><li>Significant minority of smokers had not been thinking seriously of quitting before they heard about the clinic </li></ul><ul><li>Health related reasons are the main tensions experienced by smokers </li></ul>
  18. 28. Summary of Finding (2) <ul><li>The complexity of the smokers’ feelings about quitting:- </li></ul><ul><ul><li>Majority were happy about the idea of becoming a non-smoker </li></ul></ul><ul><ul><li>More than half tried to reduce the amount of cigarettes they smoked before the appointment </li></ul></ul><ul><ul><li>Majority intended to stop smoking completely and had strong motivation to quit but about half worried they may not succeed </li></ul></ul><ul><ul><li>They enjoyed smoking, perceived smoking helped to reduce stress, stopped being bored, and to enjoy while with friends </li></ul></ul>
  19. 29. Summary of Finding (3) <ul><li>Provide new insights on how we perceive and treat smokers </li></ul><ul><li>Although smokers differed in their readiness to quit smoking early in their quit attempts, they experienced inner conflicts and had shown instability in their thoughts and feelings towards smoking and quitting </li></ul><ul><li>While in the state of vulnerability, they showed stronger emotional commitment by opting to quit abruptly </li></ul>
  20. 30. Summary of Finding (4) <ul><li>Triggers to quit smoking can happen unexpectedly, therefore the smokers are unprepared and will act upon the moment of opportunity - (Skog, O.J. 2000) </li></ul><ul><li>Those who had not been thinking to quit might be triggered to do so and may accept the offer of help and will go on to succeed - (Pisinger et a. 2005) </li></ul><ul><li>Smokers quit attempts do not necessarily happen in a structured manner and usually hard to predict. </li></ul><ul><li>If it is hard to predict smokers future behaviors, how can we ask them to plan their quit attempts? </li></ul>
  21. 31. Implications of Finding <ul><li>Recognise ambivalence in:- </li></ul><ul><ul><li>Smokers’ feelings about smoking </li></ul></ul><ul><ul><li>Substantial minority don’t mind being a smoker </li></ul></ul><ul><li>Acknowledge that many smokers take active steps before quit date </li></ul><ul><li>Recognise that a substantial minority are triggered by learning about the clinic </li></ul><ul><li>Create a challenge to health care professionals to strategise their interventions </li></ul>
  22. 32. Plans for Future Analysis <ul><li>Smokers are being followed up to assess their processes of quitting smoking and how they relate to success in the:- </li></ul><ul><ul><li>Immediate post quit period (up ~ 4 weeks) </li></ul></ul><ul><ul><li>Intermediate post-quit period </li></ul></ul><ul><ul><li>(up to ~ 3 months) </li></ul></ul>
  23. 33. Thank You
  24. 34. Acknowledgements <ul><li>We thank Dr Salehuddin Abu Bakar, Deputy Director, Dept. of Health, Federal Territories, and Putrajaya Hospital for approving this research to be carried out in their clinics. We are grateful to all the dedicated health care personnel. </li></ul><ul><li>Contributors: </li></ul><ul><li>Prof. Robert West (UCL) had the original idea for this study, data analysis and editing this paper for publication </li></ul><ul><li>Prof Awang Bulgiba assisted in the statistical analysis </li></ul><ul><li>Funding: The Ministry of Health Malaysia </li></ul>
  25. 35. Interview with Smokers
  26. 36. Training Session
  27. 37. Smoking Cessation Team
  28. 38. Quit Smoking Clinic