Section A - Profile of the interviewee

Phyo is a 25-year-old male, a Year-2 diploma student specialized in the

major of nursing at Ngee Ann Polytechnic, Singapore. He is also my senior
friend in nursing school who always helps me through my studies
whenever I need his help. Speaking of his migration background, he was
born in one of the beautiful small islands of Mon State in Myanmar.
Followed by my interviewee’s personal history, I began to ask him few
questions regarding how one of his risky health habits that has slowly
permeated into his daily routine was developed. He told me that he had
not diagnosed any life-style chronic disease yet. However, one factor he
recognised himself to have a risk for lung cancer could be tobacco use. He
became familiar with tobacco smoke since he was 15 years old. He started
smoking for no particular reason, but later found out that it was probably
by dint of the influence of his teenage friends.

His behavioural change can be reviewed under the social cognitive theory
of Albert Bandura how a person’s learning and thinking is socially
influenced by his environment. At first, he only experimented with one or
two cigarettes, but what makes him a real chain-smoker are the moments
of stress he has experienced within these few years. He gradually
increased his smoking limit from an average of 5 to 6 cigarettes
intermittently, to a pack of cigarettes on a daily basis for the months
straight when he was under a lot of stress. As such, he cultivated this bad
habit for 10 years and never took smoke breaks. As a result, he began to
suffer from shortness of breath, chest pain and recurrent coughs while
doing physical exercises. He also observed himself less physically active
than non-smokers around him.

As soon as he bewared of the negative effects of tobacco smoke leading

to lung cancer, he initiated a reduction plan by taking off the number of
cigarettes per week until he founds himself quitting completely.

Here I apply the six constructs of the health belief model to analyse my
interviewee’s health beliefs.

Perceived Susceptibility -

With persistence

He persistently smoking for 10 years and he is aware of the

Perceived susceptibility -

What I observed from my interviewee’s information was that he was being

a social-smoker at first until he became the heavy smoker. Initially with
the habit of light smoking, not only did he tend to be part of the peers, but
also he enjoyed making new friends and having conversations within the
smoking society. Being a physically strong person, he also perceived that
there were very less chances for him to experience lung cancer so that he
just ignored all the potential harmful consequences and the co-morbid
diseases related to smoking such as coronary heart diseases, heart stroke,
asthma and etc,. He, as a student nurse, actually well-gained with all
medical knowledge and understanding about the long-term effects of
tobacco use. However, I found that he had a low desire to quit smoking as
he did not fully believe the shocking impact of smoking on his wellbeing.

Perceived severity - Investigating through my interviewee’s smoking

background, besides his ignorant mindset, I could dig out some of the
concerns and fears he had that influenced his mind to change that long-
term habit. He does not care much about himself, but he seems to want to
avoid any actions that might harm his loved ones and the family. I noticed
that his biggest worry was about his younger brother with asthma attacks
living with him. If he chose to continue smoking, it would make him feel
bad and guilty for his brother, knowing that secondhand smoke can
aggravate his brother’s respiratory health more and can lead to further
complications of diseases. Another threat he expressed dismay at and
took seriously upon his behavioural change was related to what he faced
within his extended family a month ago. Mournfully and shockingly, he
talked out to me that he never wanted to realise that lung cancer caused
by smoking would have that potent to send his uncle to the early grave.
His grandfather also died of an unknown type of cancer, so the reflection
made him wonder if there is a cancer gene in their family and if it was
passed on to him.

Perceived barriers - According to my interviewee's ingrained beliefs, I

figured out 3 obstacles that interfere him with getting a diagnosis and
giving up smoking. They are stress, cost and time. First off, he revealed
that peer pressure and academic stress are the major incitements for him
to continue smoking in order to relax his mind and alleviate the stress. It
seems to be difficult for him to break off the entire smoking habit since
smoking became his go-to solution he turns to over coping with his stress.
Another interference was that the amount of money it would cost him
throughout the diagnosis process was unaffordable to him. Lastly, since he
has to take care of his sick younger brother at home, in addition to
attending his own school, he has no time to prioritize his health to
undergo medical treatments.

Perceived benefits - I analyse that there are 4 personal beliefs of my

interviewee’s to positive outcomes of quitting smoking. The first and the
most tangible immediate benefit to him is that the very high cost of
money he spends on smoking can be saved upon his daily use at once
from the day he choose to quit. Nowadays, cigarettes are becoming more
pricey and he becomes aware that continuing to smoke may affect his
future financial savings. After his encounter of the death of uncle, he
gradually realised that quitting smoke can lessen the risk of lung cancer,
so that he will not die at an early age from lung cancer like his uncle. From
his perception, it will not only increase the chances of living a longer life,
but also can reduce the potential economic costs of hospitalisation and
the likelihood of the constant dependence on caregivers if he was
diagnosed with lung cancer.

Cues to action - Based on my interviewee’s information using HBM model,

internal factors and external influences are occurred in the triggers for his
desire to break his smoking habit. For internal factors, as mentioned
above, he noticed biological alerts from all parts of his body that were
damaged by long-term smoking such as chest pain, relentless coughing,
gum-bleeding and shortness of breath during exercise. Therefore, he
started contemplating the reasons for giving up smoking as he wanted to
take control over the health hazards and his well-being back.

In terms of external factors, I discovered that his girlfriend, who is also a

dentist, was one of the primary cues to action towards his behavioural
change. He admitted that he felt impelled to quit smoking by the time his
girlfriend hit him hurt with painful words that she could accept every
imperfection from him except the smoke vapours around her and the
smell of the smoke from his breath while talking. Subsequently, he
willingly joined a tobacco cessation campaign which her friends of
girlfriend in the health community organised and invited him.
Lung cancer နဲ့ smoking ဆက်စပ်ပုံကို

Self-efficacy - In addition to the social support and cues to action he

received, on the other hand, he also developed the surge of confidence in
his mind to set his smoking limit to a minimal amount. That campaign was
also an absolute game-changer for him to build up his dedication towards
reducing the smoking limit after he had learned that the consequences of
smoking-related lung cancer were at high risk and no longer safe for him.

When the doctors facilitating the campaign mentioned that the risk of lung
cancer can be ratioed with the number of years and the amount of
cigarettes he smoked, not only did it make him anxious, but also at the
same time, he came up with the motivation and mental readiness to take
the diagnosis and start his lung recovery as soon as possible. Additionally,
among his goals of a youngster, he also has a strong desire to thrive in his
soccer skills tirelessly. Then, he is confident that his physical endurance
will improve and he will be able to stand out among his peers if he
relinquishes smoking.