POSTER OR DEMO

Motivating Resistant Smokers: Learn How to Develop Individualized Interventions

Professor Rick Botelho
Department of Family Medicine, University of Rochester, NY

ABSTRACT:

The World Health Organization's Tobacco-free Initiative aims to decrease global tobacco consumption (http://www.who.int/toh/). Currently, 4 million deaths a year are due to tobacco use, and this will rise to 10 million deaths per year within 20-30 years to cause one in eight deaths. Developing countries will account for 70% of these deaths. Yet in spite of such facts, tobacco use will remain the leading cause of death worldwide for the foreseeable future. To address this issue, the Agency for Healthcare Research and Quality Guideline on Treating Tobacco Use and Dependence (downloadable from www.ahrq.gov/guide) uses the five A's model:

1. Ask about tobacco use;
2. Advise to quit;
3. Assess willingness to quit;
4. Assist in quit attempt; and,
5. Arrange follow-up.

This basic, practical model is a good initial step, but it works with only a small minority of patients (2.3-12.2%). These guidelines don't tell us how to work with patients when proven interventions fail. Giving health information and rational advice to patients is on a par with the placebo impact of nineteenth-century drugs. The use of this "drug" over and over again, when it is clearly not working could be regarded as a form of medical error.

Knowledgeable patients often lack a critical factor: namely, motivation. Rational interventions fail with the majority of patients because emotions often overrule reason. Patients frequently decide that the short-term, emotional benefits (e.g., smoking to relax) are more important than the long-term quantifiable benefits (e.g., live longer). The guidelines provide no help on how to deal with patient's so-called "irrational" decisions, emotions, perceptions, and values. Scientific rationality lacks sophistication in addressing human irrationality.

A strictly quantitative research perspective can create a block against mainstreaming motivational approaches into health care training and practice. This left-brain, analytic approach stymies the right-brain, creative approach to developing behavioral innovations that are needed to overcome the limitations of scientific rationality in addressing patient's so-called irrational behaviors. To address this challenge, the Web site (www.MotivateHealthyHabits.com under construction) will help practitioners learn how to adopt a motivational role and begin a life long process of developing motivational skills for helping patients change over time. This Web based program can help practitioners begin the process of learning how to develop individualized interventions to help patients change process over time. To watch a video demonstration, use real player to watch http://motivatehealthyhabits.com/smoking/. This work on this web site is based on the two-part practitioner book series Beyond Advice: 1. Becoming a Motivational Practitioner & 2. Developing Motivational Skills.

BENEFIT TO PARTICIPANTS ATTENDING SESSION:

This presentation will demonstrate how this Web-based distance learning program can help practitioners initiate a process of using a continuing professional development model to enhance their motivational skills. For more details, use real player to view http://www.motivatehealthyhabits.com/intro/ A video demonstration on this Web site shows a method-focused approach to developing microskills

Dr. Rick Botelho
Professor Rick Botelho
Professor of Family Medicine and Nursing Department of Family Medicine,
Family Medicine Center,
885 South Ave.,
Rochster, NY 14620, USA
Phone: 585-442-747- ext 508
Fax: 585-758-1950
Email: Rick_Botelho@urmc.rochester.edu
Website: www.MotivateHealthy Habits.com