The transtheoretical model is one of several stage-based theories of behaviour change. It suggests that smokers move through a series of motivational stages before they manage to stop smoking. These are precontemplation (no thoughts of quitting), contemplation (thinking about quitting), preparation (planning to quit in the next 30 days), action (quitting successfully for up to six months), and maintenance (no smoking for more than six months). According to this widely-known theory, programmes which help people to stop smoking should be matched to their stage of readiness to quit. They are designed to move them forward through the stages to eventual success. In this review, we have compared stage-based programmes of smoking cessation with standard (unstaged) programmes, or with 'usual care', or with assessment only. We found 41 stage-based trials, covering more than 33,000 smokers, which measured quit rates at least six months after treatment. Only four of the 41 trials directly compared the same intervention in a standard and a stage-based version. This showed that the stage-based version was neither more nor less effective than the standard one. Eighteen trials which compared stage-based self-help programmes with any control condition showed better success rates for the intervention groups. Thirteen trials of stage-based individual counselling versus any control condition showed a similar benefit for the intervention groups. These findings confirm the known effectiveness of these interventions, whether staged or unstaged. The evidence was less clear on the effects of stage-based telephone counselling, interactive computer programmes or training of doctors and helpers. This uncertainty may be due in part to smaller numbers of trials. We find on the evidence from this review that providing self-help or counselling support to smokers trying to quit is more effective than 'usual care' or simple observation. However, the extra value of fitting that support to the smoker's stage of change is currently unclear.
Are stage-based interventions more effective than non-stage-based ones in helping smokers to quit?
10 November 2010
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