Running head: EFFECTS OF MOTIVATIONAL INTERVIEWING

Effects of Motivational Interviewing in Smoking Cessation

Gianna Constantine
University of South Florida

EFFECTS OF MOTIVATIONAL INTERVIEWING

Abstract
Clinical Problem: Patients are continuing to smoke despite receiving standard care measures to
induce smoking cessation.
Objective: To determine if smoking cessation is more likely to be achieved through motivational
interviewing as opposed to receiving standard care. PubMed and the Agency for Healthcare
Research and Quality (AHRQ) were accessed to obtain clinical trials and the guidelines about
motivational interviewing and smoking cessation. The key search terms used were smoking
cessation, motivational interviewing, standard care, and cigarette smoking.
Results: According to each RCT, as well as the clinical guideline, used in this paper, it is
recommended to use motivational interviewing opposed to standard care in order to promote and
achieve smoking cessation. One study showed that participants reduced the number of cigarettes
smoked per day when motivational interviewing was used (Mujika et al., 2015). Another study
used self-reports to measure smoking abstinence, and the results showed that more clients
achieved continuous abstinence when motivational interviewing was used over standard care
(Lindqvist et al., 2013). The third study I used reported that participants that received
motivational interviewing had less CO expired than participants that received standard care
(Jalali et al., (2015). The clinical practice guidelines state ten recommendations that proved to
enhance smoking cessation, one of which is motivational interviewing.
Conclusion: Patients that receive motivational interviewing over standard care will be more
likely to quit smoking than patients that receive standard care. Following up with the patients
that quit smoking to ensure continuous cessation also proved as efficient.

Effects of Motivational Interviewing in Smoking Cessation

EFFECTS OF MOTIVATIONAL INTERVIEWING

According to the Center for Disease Control and Prevention (2008), cigarette smoking is
responsible for over 480,000 deaths per year in the United States, including incidences where
secondhand smoking is involved. The goal to reduce the number of deaths in the United States
due to smoking is a huge goal, and this starts within the hospitals through patient education.
Currently, there are many different types of education being used in hospitals to teach patients
about the dangers of smoking and the positive effects that quitting can have. Examples of this
standard care are educational videos, pamphlets handed out at discharge, and encouraging some
type of nicotine replacement therapy. While these teaching opportunities prove to be effective
with some people, they are not that as effective as other types of education, such as motivational
interviewing. This paper evaluates the effectiveness of motivational interviewing in inducing
smoking cessation. In current adult cigarette smokers, how does integrating motivational
interviewing compared with standard care affect the rate of achieving smoking cessation over the
duration of three months?
Literature Search
PubMed and the Agency for Healthcare Research and Quality (AHRQ) were accessed to
obtain clinical trials and the guidelines about motivational interviewing and smoking cessation.
The key search terms used were smoking cessation, motivational interviewing, standard care,
and cigarette smoking.
Literature Review
Three randomized controlled clinical trials and one guideline were used to evaluate the
efficacy of motivational interviewing on smoking cessation. Using a randomized controlled
clinical trial, Jalali et al. (2015) compared the effects of motivational interviewing-based
treatment and its combination with nicotine replacement therapy on smoking cessation in

EFFECTS OF MOTIVATIONAL INTERVIEWING

prisoners at Mashhad Central Prison. Two hundred and thirteen prisoners were used for the trial.
They were divided randomly into the control and experimental groups. The mean CO
concentration expired in the air between the group that only received motivational interviewing
and the group that received motivational interviewing and nicotine replacement therapy proved
to be statistically significant (p< 0.001). This value was determined at the pre-test and the posttest, however, between the post-test and follow up, the amount of CO expired in the air between
the two groups proved not to be statistically significant (p> 0.50). Furthermore, results stated that
the CO concentration in the expired air in the motivational interviewing with nicotine
replacement therapy group proved to be more efficient, due to greater amounts of smoking
cessation compared with the control group and the group that only received motivational
interviewing after the follow up (p= 0.02). The main weakness of this trial was that prisoners
were only used from one specific prison. Another weakness is that the prisoners in the control
group who received no therapy were also never encouraged to quit smoking voluntarily, and the
follow-up period of 90 days excludes prisoners that relapsed after the 90-day follow-up. One of
the main strengths of this study is that each group consisted of the same amount of prisoners
(n=71). Prisoners were also randomly assigned to the control or intervention group. Other
strengths include that measuring smoking cessation was valid by using the amount of CO expired
in the air, and the control group was appropriate.
The randomized controlled trial conducted by Lindqvist et al. (2013) assessed the effect
of adding motivational interviewing to the first session of a smoking cessation treatment protocol
in a clinical setting, the Swedish National Tobacco Quitline (SNTQ). Seven hundred and seventy
two clients accepted invitations to the study. These clients were randomized to either a standard
treatment group or the motivational interview group. The outcome measures were self-reported

EFFECTS OF MOTIVATIONAL INTERVIEWING

at a seven-day point to determine abstinence, and a six-month point to determine continuous

abstinence. At the twelve-month follow up, the 772 clients were put in an intention to treat
analysis. Of the clients that received the intervention, 19% reported six-month continuous
abstinence. Of the clients that received standard care, 14% reported six-month continuous
abstinence. The p value= .047. The main weakness of this clinical trial was that outcome
measures were self-reported, so some clients may have lied. A lot of clients also dropped out of
the study at follow-up, and this affects the statistical credibility of the study. Clients were
randomly assigned to the control group or the intervention group. All SNTQ counselors had
received at least six months of training in tobacco cessation, which included coaching skills and
cognitive-behavioral therapy techniques. This study also assessed treatment fidelity, which
monitored and enhanced the accuracy and consistency of an intervention.
The trial conducted by Mujika et al. (2013) compared the effects of motivational
interviewing with standard care, such as brief advice, on nurses at a large teaching hospital in the
North of Spain (n=30). The nurses were split into two groups, one was a control group that
received standard care (n=15), and the other was the intervention group that received
motivational interviewing (n=15). The idea of this study was to not only help promote smoking
cessation, but to determine if nurses who had succeeded in quitting have a higher chance of
getting their patients to quit smoking as opposed to nurses that continue to smoke. Outcome
measures were reported after 90 days, and the results were based off of how many cigarettes
smoked per day. Compared with the control group, more nurses in the intervention group had
quit smoking. There was an absolute difference of 33%, and a 95% confidence interval (CI of
2.6-58.2). In the nurses that did not quit, there was no difference between the intervention and
control groups in the number of cigarettes smoked per day, however, the nurses in the

EFFECTS OF MOTIVATIONAL INTERVIEWING

intervention group progressed in the stages of change. There were also higher levels of
attendance and completion in the intervention group. Some limitations to the study included
using a small population, as well as a follow-up period of three months. According to this study,
best practice guidelines recommend that the length of follow up should be at least six months.
The major weakness of this trial is that a very small sample size was used for this study, which
included only thirty people. The follow-up period was also only three months, when practice
guidelines recommend a follow-up length of at least six months. The major strengths of this trial
is that each group consisted of the same amount of nurses (n=15), nurses were randomly
assigned to the control group or the intervention group, and the control group was appropriate.
The guidelines for smoking cessation and tobacco treatment by the Center for Disease
Control and Prevention (CDC) and retrieved from Agency for Healthcare Research and Quality
(CDC, 2008) incorporates evidence-based practice from over 8,700 research articles to come up
with ten recommendation guidelines to follow to promote smoking cessation. The CDC
recommends motivational interviewing, social support, and numerous medications as just a few
interventions that healthcare providers can follow and implement in their patient care.
Synthesis
Jalali et al. (2015) demonstrated that the amount of CO expired in the air by participants
significantly decreased after receiving motivational interviewing (p < 0.001). Additionally,
Lindqvist et al. (2013) reported an increase in smoking abstinence at the six-month follow up in
the patients that received the motivational interviewing (p=0.47). Mujika et al. (2013) reported a
significant reduction in the number of cigarettes smoked per day by the participants that received
motivational interviewing opposed to the participants that received only standard care (CI of 2.658.2). Finally, the Centers for Disease Control and Preventions (2008) guideline proposes that

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patients receive motivational interviewing as well as other techniques to promote smoking

cessation.
Research demonstrates that providing motivational interviewing to current smokers will
increase the likelihood that they will quit. Once the number of cigarette smokers decreases, the
number of deaths due to cigarette smoking will decrease. Additional research is needed to
determine how smoking cessation can be even further promoted after motivational interviewing
has ceased. Follow up periods of only six months are not long enough to determine if the
smokers will continue to be abstinent.
Clinical Recommendations
The CDC (2008) guidelines demonstrate that patients who currently smoke should be
receiving motivational interviewing as well as nine other interventions to promote smoking
cessation. Furthermore, motivational interviewing can be combined with nicotine replacement
therapy, brief tobacco treatments, telephone quitline counseling, and a combination of counseling
and medication. Providing coverage for these treatments has shown to increase quit rates. If
insurers and purchasers were more aware of coverage for counseling and medication, the number
of people that quit smoking would decrease even more. Supplemental research needs to be
performed to evaluate if motivational interviewing can impact the mortality rate of cigarette
smoking.

References

EFFECTS OF MOTIVATIONAL INTERVIEWING

Agency for Healthcare Research and Quality (2013). Treating tobacco use and dependence.
Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines
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Centers for Disease Control and Prevention (2008). Cessation materials for state tobacco
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index.htm
Centers for Disease Control And Prevention (2014). Smoking & tobacco use: fast facts.
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Jalali, F., Afshari, R., Babaei, A., Abasspour, H., & Vahedian-Shahroodi, M. (2015). Comparing
motivational interviewing-based treatment and its combination with nicotine replacement
therapy on smoking cessation in prisoners: A randomized controlled clinical trial.
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