1. Motivational enhancement Alison Bell and Tracey Greenberg, NSW Health Tobacco Cessation Trainer

2. “Are we Dancing or Wrestling?”

3. Definition of Ambivalence “Conflicting thoughts and feelings towards someone or something”

4. Initial Aim Minimise the language of defence and maximise the language of doubt and change.

5. 1. This person ought to change 2. This person wants to change 3. This person’s health is a prime motivating factor for them 4. If he or she don’t decide to change, the intervention has failed 5. People are either motivated to change or not 6. Now is the right time to consider change 7. A tough approach is always best 8. I’m the expert. He or she must follow my advice.

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7. Key Questions for Eliciting Change Conversation Problem Recognition: “What things may happen if you continue to smoke?” “What have other people said about your reluctance to quit smoking “How might your smoking have stopped you from doing other things you want to do?”

8. Key Questions for Eliciting Change Conversation Expression of Concern: “What is there about your smoking that you or other people might see as reasons for concern?” “What are some of the hassles that your smoking may have caused?” “How does your smoking fit in with your diabetes?”

9. Key Questions for Eliciting Change Conversation Intention to Change: “What are some of the reasons you might like to quit smoking?” “What might be some of the advantages in setting a quit date “If we were to bump into each other on the street in six months time, what do you think you would you like to tell me about your smoking status at that point?”

10. Key Questions for Eliciting Change Conversation Optimism about Change: “What are the things that you would like to have in your life instead of tobacco?” “If you did make a change to your lifestyle, how would you like things to turn out?” “Who are the people in your life that would support you in quitting?”

11. Strategies for Encouraging Change Conversation A typical day/session Good things/less good things Looking back/past experiences Looking forward/future directions Using extremes Exchanging information

12. Ask the key question: “What are some of the good things about your use of ………..” Ask the next key question “What are some of the less good things about your use of ……..” Summarise the good things and less good things in ‘you’ language, leaving the client time to react.