Predictive Value of the Transtheoretical Model to Smoking Cessation in Hospitalized Patients with Cardiovascular Disease

Abstract

Background: Several authors have questioned the Transtheoretical Model (TTM). Determining the predictive value of each cognitive-behavioural element within this model could explain the successes reported in smoking cessation programs. The purpose of this study was to predict point-prevalent smoking abstinence and progression through stages of change at 2 and 6 months, using the constructs of the TTM, when applied to a pooled sample of individuals who were hospitalized for a cardiovascular event. Methods: In a predictive correlation design, recently hospitalized patients (N = 168) with cardiovascular disease (CVD) were pooled from a randomized controlled trial. Independent variables of the predictive TTM comprise stages and processes of change, pros and cons to quit smoking (decisional balance), self-efficacy, and social support. These were evaluated at baseline, 2 and 6 months. Results: Compared with smokers, individuals who abstained from smoking at 2 and 6 months were more confident at baseline to remain non-smokers, perceived less pros and cons to continue smoking, utilized less consciousness raising and self-reevaluation experiential processes of change, and received more positive reinforcement from their social network with regard to their smoke-free behaviour. Self-efficacy at baseline was the only element which predicted that patients would progress through the stages of change between hospital discharge and 6 months. Conclusions: Self-efficacy was the only element which predicted smoking abstinence and progression through stages of change. Observations about the other elements are congruent with the TTM. This study provides important information regarding the application of the TTM to smoking cessation in CVD patients.