1. Changing, ready or not Stephanie Cowan Education for Change September 2007

2. Education for Change www.efc.co.nz 2 Context Our intervention challenge  Pregnancy  Low self-efficacy  “Quit” approach the norm Design  Inclusive  Response to dose effects  Change approach

3. Education for Change www.efc.co.nz 3 Smokechange Health funded Home visits Personalised Change focus Family, too Dual goals  More people smokefree  More people ready to consider it

4. Education for Change www.efc.co.nz 4 Measurement Principle  We value what we measure, so, let’s measure what we value Value  Readiness  Intervention steps  Personal change steps Assessment  Tools

5. Education for Change www.efc.co.nz 5 Assessing readiness Ask: What do you feel ready to do about smoking…  Hold?  Reduce?  Stop? Smokechange Test  8 factors, points assigned, score calculated, feedback given

6. Education for Change www.efc.co.nz 6 Study group Included in the analysis were:  1320 women  All smoking at enrolment  All participated to 6 month assessment  All completed programme  Period: 1/1/2005 to 30/6/2007

7. Education for Change www.efc.co.nz 7 Ready vs not most women (76%) did not feel ready to stop smoking at enrolment (n=1001)

8. Education for Change www.efc.co.nz 8 Personal factors Ready N=319 Not ready N=1001 Significance Teenaged 1113ns Pregnant 7279ns Maori 3036ns Pacific 14 ns NZ European 5956ns Other 86ns Low income (CSC holder) 5560ns No partner 14 ns Personal comparisons between ready and not ready people (n=1320)

9. Education for Change www.efc.co.nz 9 Readiness factors Ready N=319 Not N=1001 Significance Light smoking (<10/day) 5639p<0.0001 First smoke after 60 mins 4331p<0.0001 Recent smokefree attempt 3821p<0.0001 No others smoking at home 3127ns High importance 9474p<0.0001 High confidence 7028p<0.0001 High knowledge 6865ns Low personal stress 3022ns Readiness comparisons between ready and not ready people

10. Education for Change www.efc.co.nz 10 Purpose  Build capacity and confidence to:  Consider and plan  Achieve and maintain change Strategy  Build smokefree:  Thinking  Habits  Talk Intervention for working with “not ready” people

11. Education for Change www.efc.co.nz 11

12. Education for Change www.efc.co.nz 12 Readiness factorsAt the startAt 6 months Light smoking (<10/day) 3977 First smoke after 60 mins 3174 Recent smokefree attempt 2165 No others smoking at home 2738 High importance 7480 High confidence 2858 High knowledge 6594 Low personal stress 2227 Smokefree 031 Changes made by the 1001 people in the “not ready” group

13. Education for Change www.efc.co.nz 13 Programme outcomes distribution of women smokefree or not at 6 months by ready or not at enrolment (n=1320)

14. Education for Change www.efc.co.nz 14 Smokefree outcomes only distribution of women smokefree at 6 months (35%) by ready or not at enrolment (n=458)

15. Education for Change www.efc.co.nz 15 Most people were “not ready” (76%) Compared to “ready” people, they had:  significantly more barriers to change  social and ethnic similarities I in 3 succeeded in being smokefree at 6 months (31%) “Not ready” people made up two thirds of those eventually smokefree at 6 months What we have learnt about the “not ready” group (n=1001)

16. Education for Change www.efc.co.nz 16 Ready group  smaller group (24%)  higher smokefree rates (48%)  fewer people smokefree(152) Not ready group  larger group (76%)  lower smokefree rates (31%)  more people smokefree (306) Summary

17. Education for Change www.efc.co.nz 17 To have an impact on the public health, programmes need to achieve smokefree change in the larger, “not ready” group, too. Conclusion Thank you.