4. Discussion
smoking reduction, diabetic
MAY
Although this study was suspended from May 2021 due to COVID-19 restrictions for epidemic prevention and drug recall in Taiwan, which impeded us from recruiting the expected number of subjects and caused a smaller sample size, this study still found that the health coaching intervention seemed to enhance the effectiveness of smoking cessation in diabetic patients, especially those who participated in the pharmacotherapy plan. Patients in the intervention group showed a significant smoking reduction, and, even if they did not participate in the pharmacotherapy plan, health coaching seemed to help the patients to reduce smoking effectively; this seems to be consistent with the current rather limited study evidence [In the multivariate analysis, it appears that coaching intervention did increase the effectiveness of using varenicline for smoking cessation. Although the 95% CI was larger due to the small sample size, it seems that exploring the use of both coaching to assist in smoking cessation and varenicline is an interesting research topic. In the past, although there were no studies on the use of health coaches to enhance varenicline or nicotine replacement therapy (NRT), some studies tried to use MI for testing [The smoking cessation rate in the intervention group was about 48.6% in this study, which is about twice the reported smoking cessation rate of smoking cessation services in Taiwan (27.1% in 2020) [There are some hospitals in Taiwan trying to provide MI element health education or conduct related studies [Our study did not find significant impacts of demographic characteristics, smoking experience, or smoking cessation experience on smoking cessation rates, but we found that the number of daily cigarettes did significantly affect the success rate of smoking cessation, which aligns with some study evidence [On the basis of our findings, health coaching intervention in smoking cessation seemed to have significantly higher quit rates when combined with a pharmacotherapy plan. Given that smoking cessation is a complex behavior involving lifestyle changes, addiction symptoms, and side-effects, we do not consider health coaching to be ineffective per se, but rather an effective element of a smoking cessation program that can bolster an original medication program. Hence, the study proposes some suggestions for future studies and our medical system. Firstly, more full-time professional behavior coaching services need to be introduced in Taiwan. The current medical system greatly limits the time and effectiveness of communication between doctors and patients, and there is also a lack of adequate smoking cessation behavior counselors with rigorous training and regular fidelity supervision. Secondly, more studies on health coaching with high-quality evidence are needed. Although this study seemed to have acceptable results, the number of samples did not meet the recruiting expectations, and the research was interrupted by the restrictions which could have affected the effectiveness of the evidence in this study.Although this study was not completed as scheduled, it still had some strengths. Firstly, the original randomized controlled design allowed this study to retain a certain degree of evidence, even if it was affected by some problems as described above, and smoking cessation studies specifically for diabetic patients are also quite rare. Secondly, the use of rigorously trained and certified coaches to perform the smoking cessation counseling was also one of the strengths in this research, as it may have greatly improved the quality of coaching. The training and practice fidelity of the coaches remain important factors influencing research in such behavioral interventions [