IDENTIFYING THE PERSON NOT READY TO QUIT

The process of quitting tobacco use is not straightforward, and often takes a great deal of patience and
understanding on the part of the health worker, as well as the patient. In the previous module we have
been introduced to the Readiness to Change model, and this will frame our thinking in how to go about
helping someone quit tobacco use.

Figure 3.1. Readiness to Change Model

As we can see from the Readiness to Change Model, everyone starts at the Not Ready to Quit phase, and
more often than not, we will encounter smokers who have not yet thought about quitting.

THE FIVE A’s:

Ask, Advice, Assess, Assist, and Arrange

We start off again with the first of the Five A’s: asking the patient if they use tobacco. For Module 3, we
will be handling patients who are not yet ready to quit, defined as:
Individuals with no intention to quit within the next 6 months.
Note: Clients who are not willing to quit within the next 30 days are also NOT ready to quit.

BTI: Module 3. Not Ready to Quit 1

Ask about tobacco use. As we learned in Module 2, there are two simple questions to be asked: “Do you
use tobacco?” and “Does anyone in your home use tobacco?”. We expect that around 40% of smokers
are not thinking about quitting or are not ready to quit.

Once faced with people unwilling to quit, we should always remember to not show any signs of being
judgmental, and we should not pressure the tobacco user into quitting.

Advise the tobacco user through a brief motivational message. Remind the person of the benefits of
quitting and discuss the harmful effects of tobacco use. Remember to provide advice in a supportive but
clear manner, such as offering information without any value judgement.

Assess any willingness to quit and willingness to discuss. Assess willingness to quit by asking, “Are you
ready to set a date to quit within the next 30 days?” After we assess the person’s willingness to quit, we
should check if they are willing to discuss quitting. For people who are not yet ready to quit, discussion is
often out of the picture at this stage. Provide a brief motivational message as appropriate.

Assist the tobacco users by providing literature and self-help materials. The brief intervention for people
at this stage is very short as they are unwilling to discuss the issue further. So, limit our intervention for
now to the provision of educational materials that might help persuade them to stop tobacco use.

Arrange for a follow-up whenever the person is ready to quit. We can tell the patient that whenever they
are ready to quit, you will make yourself available to help them. Inform them that you will continue to ask
about their tobacco use (Fiore et al.,1996). Clarify your availability and how they can reach out to you.

Just to emphasize: we should not be judgmental about their decision, and should not talk the patient into
quitting.

BRIEF INTERVENTION WITH A TOBACCO USER WHO IS

NOT READY TO QUIT

Watch the video role-play of a brief intervention with a tobacco user who is not yet ready to quit.

The BTI Flowchart and the Self-help Materials will be used during the intervention.

 Open the BTI Flowchart to follow the steps covered in the role-play.
 Note that since the tobacco user is not ready to set a quit date within the next 30 days, the inter-
vention requires only the first two panels of the BTI Flowchart.

BTI: Module 3. Not Ready to Quit 2

  Identify the statements or actions taken by the characters during the role-play cover the Five A’s.
 Identify where you think the person might be as far as readiness to quit. Is there a difference in the
intervention because of this?

KEY POINTS TO REMEMBER

 Do not pressure individuals who are not yet ready to quit.

 The intervention at this stage is expected to be short as we are accommodating the tobacco user’s
hesitance to quit. Offer information and support through a brief motivational message. Not all of
the panels in the BTI Flowchart needs to be used at all times.
 Remember the Readiness to Change Model.

BTI: Module 3. Not Ready to Quit 3

 This e-book and related documents are intended for use
by a broad range of healthcare and non-healthcare
professionals (private or government). It is based on the
Brief Tobacco Intervention training curriculum developed by
Health Partners Limited Liability Corporation in Guam, USA,
and is customized based on the Philippine context.

All rights reserved.

The mention (if any) of specific companies or of certain

manufacturer’s product does not imply that they are endorsed or
recommended by the Department of Health (DOH) in reference over
others of a similar nature. Reproduction in full or in part of this e-
book for educational or other non-commercial purposes are
authorized without any prior written permission from the copyright
holder, provided the source is fully acknowledged as indicated
below. Reproduction for profit or for commercial purposes is
prohibited without written permission from the copyright holder.

Suggested citation: Department of Health (2019). Philippine Brief

Tobacco Intervention Course E-book. Manila, Philippines:
Department of Health.