2.3. Intervention
smoking behavior, MIs, cognitive behavior, diabetes
DIABETES
Patients in the intervention group received in-person coaching at baseline and were followed up by a monthly telephone call for a total of 6 months, or they could participate in the pharmacotherapy plan and have a coaching intervention the other 4 months. Coaching was provided on a one-on-one basis by a professional health coach who has a master’s degree in public health and received over 120 h of coach training before being certified as an International Coach Federation (ICF)’s Associated Certified Coach (ACC).To be specific, the coach used techniques such as MIs, appreciation inquiry, and value exploration to arouse participants’ motivation to quit smoking and allowed participants to weigh the pros and cons of quitting smoking due to diabetes and the needs of their personal work or family life. The coach used the patient-centered principle, self-determination theory, and transtheoretical model to guide the patients to think via techniques such as active listening and open-ended questions, instead of using traditional preaching methods of health education, thereby strengthening the psychological support and motivation felt by the patients. For some patients who have irrational beliefs about smoking behavior, such as the belief that smoking is a necessary means to establish working partnerships or carry out their creative work, the coach tried to use rational emotive cognitive behavior coaching (RECBC) skill for coaching.In the first session, the coach asked each participant to establish their 6 month smoking cessation goals, and then the coach assisted them in formulating a plan to gradually reduce smoking. Participants needed to design “SMART” (i.e., specific, measurable, attainable, realistic, and timely) goals for their action plans, and they could design a smoking reduction plan on a weekly or monthly basis, or just stop smoking straight away. In addition, the coach also asked the participants if they felt the need to use smoking cessation drugs, and some decided to participate in the pharmacotherapy plan during or after the initial coaching session. Most coaching calls were made while the participants were at home or during lunch break. During follow-up telephone coaching sessions, the coach continued to enhance each patient’s motivation to quit smoking, reviewed the goal and action plan with the patient, and discussed possible obstacles to quitting and the solutions together. Through coaching, each patient could rethink the necessity of smoking and its health effects; however, even if the patient chose to just reduce the number of cigarettes instead of quitting smoking entirely due to work or family needs, the coach still respected the patient’s choice. In general, it took more time, about 30–45 min, in the first coaching session than in follow-up telephone coaching sessions.Both intervention and control group patients received the usual smoking cessation education and tracking. Currently, the smoking cessation health education adopted in Taiwan includes the five As (ask, advise, assess interest, assist, and arrange) and five Rs (relevance, risks, rewards, roadblocks, and repetition) strategy of smoking cessation promoted by the WHO to strengthen the effectiveness of smoking cessation [