Patient autonomy is an essential factor in motivating effective change in health behavior

Counselors were more successful in motivating smokers to quit when they explored the smokers' personal values, discussed their knowledge of the health risks, and supported patients as they tried to solve their problem, a University of Rochester study has found.

After at least four sessions during a six-month period, the smokers were more likely to make a serious attempt to quit--49.7 percent versus 39 percent for those getting community care--and to use medications to help them stop, preliminary results show.

"The intervention was found to motivate patients to quit whether they reported wanting to or not at the start," said Dr. Geoffrey Williams, the study's principal investigator and associate professor at the University of Rochester School of Medicine and Dentistry. The Smokers' Health Project accepted 1,000 participants during the past four years and invited all of them to talk about health, diet, and smoking issues during their sessions.

At the end of four visits, if participants decided not to quit in the next 30 days, they left the group with general information, a referral to their physician, and to other smoking cessation programs in Rochester. Even for that group, "the long-term quit rate nearly tripled" when they participated in the program, the study found.

The initial research study was funded by the National Institutes of Health. NIH recently awarded the researchers an additional $2.8 million grant over five years to recruit more people for the next phase of the project.

"Although there are effective interventions to help people break the smoking habit, little is known about what motivates people to do it," explained Williams. The team of Williams, faculty members Edward Deci and Richard Ryan from the University's Department of Clinical and Social Sciences in Psychology, and Daryl Sharp, assistant professor and psychiatric nurse practitioner from the University's School of Nursing, is trying to understand more about how smokers see their health, and how the patients' perspective on their health may motivate change.

The Smokers' Health Project was developed to test the use of Self-Determination Theory to encourage healthier behavior among smokers. This involved an examination of the participants' health-related concerns and behaviors, and a choice on their part about how to behave. The theory, which was developed by Deci and Ryan, espouses that people are inherently motivated to behave in healthy ways, but other factors sometimes interfere with this motivation. By supporting people's basic psychological needs for autonomy, competence, and relatedness, people become more ready to change their behavior and achieve a sense of well-being in their lives.

"We believe that patient autonomy is an essential factor in motivating effective change in health behavior," said Deci, professor of psychology. "Our approach enhanced the patients' feeling of 'autonomy' or full agreement with the actions they were taking in their lives."

The researchers described this as the first trial to produce an intervention that yielded a measurable increase in patient autonomy. When the clinicians focused on enhancing patient autonomy, the smokers expressed more willingness to use medications to quit, greater confidence in succeeding, and eventually greater abstinence.

Those in the study were at least 18 years of age, smoked at least five cigarettes a day, and had given some thought to quitting. They were recruited from the Rochester area and met with the project's staff for information about their smoking and diet. Those who did not receive all the counseling interventions were encouraged to consult their physician and use resources available in the community. They also were given a list of smoking cession programs and information about their health status.

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