Abstract
Objective: Within the framework of a randomized, active treatment controlled trial, we used a mediation analysis to understand the mechanisms by which an intervention that uses confrontation with spirometry for smoking cessation achieves its effects.
Methods: Participants were 228 smokers from the general population with previously undetected chronic obstructive pulmonary disease (COPD), who were detected with airflow limitation by means of spirometry. They received two equally intensive behavioural treatments by a respiratory nurse combined with nortriptyline for smoking cessation: confrontational counselling with spirometry versus conventional health education and promotion (excluding confrontation with spirometry and COPD).
Results: Cotinine validated abstinence rates from smoking at 5 weeks after the target quit date were 43.1% in the confrontational counselling group versus 31.3% in the control group (OR = 1.67, 95%CI = 0.97-2.87). The effect of confrontational counselling on abstinence was independently mediated by the expectation of getting a serious smoking related disease in the future (OR = 1.76, 95%CI = 1.03-3.00), self-exempting beliefs (OR = 0.42, 95%CI = 0.21-0.84), and self-efficacy (OR = 1.38, 95%CI = 1.11-1.73).
Conclusion: We conclude that confrontational counselling increases risk perceptions and self-efficacy, and decreases self-exempting beliefs (risk denial) in smokers with previously undetected COPD. These changes in mediators are associated with a higher likelihood of smoking cessation. Practice implications: Apart from the intensity, the content of smoking cessation counselling may be an important factor of success. A confrontational counselling approach as we applied may have the potential to alter smoking-related cognitions in such a way that smokers are more successful in quitting. Nurses can be trained to deliver this treatment.
| Original language | English |
|---|---|
| Pages (from-to) | 16-24 |
| Journal | Patient Education and Counseling |
| Volume | 76 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2009 |
| Externally published | Yes |
Bibliographical note
Funding Information:This study was funded by grants from the Dutch Asthma Foundation, Partners in Care Solutions for COPD (an initiative of the School for Primary Care and Public Health (CAPHRI), Boehringer Ingelheim, and Pfizer), and Maastricht University Hospital. The sponsors were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Funding Information:
The authors gratefully acknowledge the contributions of Kitty van der Meer (telephonic screening, logistics), Arja van de Voorde, Ellen de Goeij (spirometry), Marleen Vaassen, Hilde Bastiaens, Rianne Romers, Tim Sales, Karin Frambach (respiratory nurses), Mischa Aussems (validation spirometric test results), Willem de Goeij (database construction), Ger Driessen and Paula Rinkens (data cleaning), Hendrikus Boersma (pharmacist), and Arnold Kester (statistical advice). Daniel Kotz is the recipient of a European Respiratory Society Fellowship (Number 351).
Funding
This study was funded by grants from the Dutch Asthma Foundation, Partners in Care Solutions for COPD (an initiative of the School for Primary Care and Public Health (CAPHRI), Boehringer Ingelheim, and Pfizer), and Maastricht University Hospital. The sponsors were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors gratefully acknowledge the contributions of Kitty van der Meer (telephonic screening, logistics), Arja van de Voorde, Ellen de Goeij (spirometry), Marleen Vaassen, Hilde Bastiaens, Rianne Romers, Tim Sales, Karin Frambach (respiratory nurses), Mischa Aussems (validation spirometric test results), Willem de Goeij (database construction), Ger Driessen and Paula Rinkens (data cleaning), Hendrikus Boersma (pharmacist), and Arnold Kester (statistical advice). Daniel Kotz is the recipient of a European Respiratory Society Fellowship (Number 351).
Keywords
- Chronic obstructive pulmonary disease (COPD)
- Confrontational counselling
- Mediation analysis
- Smoking cessation
- Spirometry