Introduction
Health literacy is the “capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions” (Centers for Disease Control and Prevention, 2014). Smoking is a common addictive behavior and is bad for health status in many ways. According to World Health Organization (2014) tobacco kills nearly six million people per year. Therefore, it is important to promote people’s health literacy of smoking through effective intervention to improve health condition. Brief intervention is an effective method to deliver suitable information and increase the motivation of clients to change the substance use (Substance abuse and mental health service, 2014). Nurses can make good use of brief intervention to improve the health literacy among clients with resultant better health outcomes. This essay will firstly describe the potential health impacts of smoking on individual in Australia and globally. Secondly, it will use a case to analyze the smoking through stage of change model and discuss three approaches to change the behavior. Thirdly, it will choose the most sustainable strategy to provide health literacy to the client. Lastly, I will discuss how changing a singles person’s behavior can contribute to global health.
Overview of smoking
Cigarette contains more than 7,000 chemical substances and most of them are harmful to our body. Once inhaled into the lung, these chemical compounds will be carried to all the tissues of our body through blood (Centers for Disease Control and Prevention, 2014). Smoking will impair the normal growth and function of the cells and result in cancer tumor growth. Research showed that smoking can cause many kinds of cancers in our body such as larynx, lung, mouth, nose, and throat cancer (U.S. Department of Health and Human Services, 2010). For the cardiovascular system, smoking will damage our blood vessels with plaque formation and produce thicker vessel walls and narrower lumen. Therefore, smoking is a major risk factor for stroke and coronary heart disease (U.S. Department of Health and Human Services, 2010). Smoking also causes damage to the respiratory system, especially the airway and alveoli. The research showed that chronic obstructive pulmonary disease including emphysema and chronic bronchitis are most commonly related to smoking. In addition, smoking will also affect the fertility and immune system and increase the chance to have type 2 diabetes (Centers for Disease Control and Prevention, 2014). Last but not least, secondhand smoke causes adverse effects such as cardiovascular and respiratory diseases to the peers, family and community. In conclusion, smoking might impact the whole body and result in serious health problem.

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According to World Health Organization (2014), smoking is related to more than 6 million people’s death; 5 million die directly due to tobacco use and 600,000 people die from exposure to secondhand smoke. In Australia, around 3.1 million people (19.5%) are current smokers aged over 18 years old and among them 20.4% male and 16.3% female are daily smokers (Australian Bureau of Statistics, 2011). Smoking was responsible for 20% of cancer death in Australia and around 45,000 hospitalisations in New South Wales were related to smoking (Cancer Council NSW, 2013). In addition, nearly 600,000 people (3.6%) reported at risk of having heart disease and other chronic conditions due to using tobacco products (Australian Institute of Health and Welfare, 2013). Smoking is a common unhealthy behavior not only in Australia but all over the world and contributes to many diseases and death.
Incident of smoking
Mr. C is a 55 year old man who comes from Taiwan and works as an accountant in a computer company. He had a history of smoking around 30 years since graduated from senior high school. He usually smokes 10-12 cigarettes a day. Mr. C has the medical history of type 2 diabetes. He believes that smoking can help him release the stress and anxiety. He really enjoys the moment of smoking and states that smoking can stimulate thinking. However, Mr. C developed productive cough recently and had shortness of breath when climbing the stairs. He went to see a general practitioner and the physician informed him that the productive cough and shortness of breath are related to smoking. Therefore, the general practitioner gave Mr. C a handbook about the information of smoking and suggested him to quit smoking. After seeing the general practitioner, Mr. C read through the handbook and tried to search the internet for relevant information. He also discussed with his family and all of his family supported him to quit smoking. Mr. C hesitated about stopping smoking. Because he thought that smoking was a good method for him to relieve the stress and serve as a social skill to maintain the relationship with friends and colleagues. In addition, he also considers that to quit smoking will be a long process and takes a lot of time to give up smoking and will incur a lot of physical discomfort. Mr. C is now feeling ambivalent about quitting smoking but he wants the symptoms such as productive cough and shortness of breath to go away. Therefore, he still considers smoking to be an enjoyable hobbit and cannot really give up smoking.
Stage of change model
Stage of change model (Transtheoretical model) is a theory of behavior change which was developed by Prochaska and DiClemente. It contains 5 stages of changes: precontemplation, contemplation, preparation, action and maintenance (Australia government Department of health, 2004; Prochaska, DiClemente & Norcross, 1992, p. 1103). Stage of change model is a good method to assess the readiness of clients to change the additive behavior such as smoking (Mallin, 2002, p. 1107). According to Prochaska, DiClemente and Norcross (1992, p.1103), contemplation is the stage that clients are aware the adverse effects due to the behavior and consider to change, however have not determined to establish a plan of action. In this incident, Mr. C has some physical discomfort such as productive cough and shortness of breath during the activity. Therefore, Mr. C went to a general practitioner for the assessment and found out that smoking was the root cause of the symptoms. Mr. C started to search the information about smoking and also discussed with his family. However, Mr. C did not make a promise to quit smoking. Due to these features, Mr. C is at the stage of contemplation.
Another concept of the contemplation stage is that patient is ambivalent about the advantage and disadvantage of the behavior (Prochaska, DiClemente & Norcross, 1992, p. 1103). The client realizes the behavior will be harmful to the health condition but still considers the behavior to be with value (Australia government Department of health, 2004). In this case, Mr. C states that smoking is a good method for him to relieve the stress and a social tool to maintain the relationship with friends and colleagues. He did not want to give up this 30 years hobbit. However, Mr. C also wanted to improve the symptoms. Mr. C is hesitated in making the decision to quit smoking. Therefore, it is obvious that Mr. C is at the stage of contemplation.
Multiple approaches to change smoking
Motivational interviewing is a counseling technique which can assist clients to increase the motivation to change the addictive behavior (Miller, 2010, p. 247; Ridner, Cloud, Ostapchuk, Myers, Jorayeva & Ling, 2014, p. 314). Clients can be explored and their ambivalence could be resolved about quitting smoking through motivational interviewing (Lai, Cahill, Qin & Tang, 2010). The four principles of motivational interviewing are expression of empathy, develop discrepancy, roll with resistance and support self-efficacy (Miller, 2010, p. 248). During the motivational interviewing, nurses can understand the ambivalent feelings of the clients, the difficulties of changing and discuss the advantage and disadvantage of quitting smoking with clients. In addition, it might enhance the client’s desire to change. Nurses might use the reflective listening, open-ended questions, affirmation and summarization techniques to understand the clients’ position and have good communication (Miller, 2010, p. 249; New South Wales Department of Health, 2005). A research (Ridner, Cloud, Myers, Jorayeva & Ling, 2014) found out that after the motivational interviewing, the patients smoked less cigarettes, had a higher score of self-efficacy and lower nicotine dependence. Soria, Legido, Escolano, Lopez Yeste and Montoya (2006) pointed out that motivational interviewing group has higher success rate compared to anti-smoking advice group. In addition, the article also showed that motivational interviewing could help clients move to the next stage of change model. The above evidence showed that motivational interviewing is an effective brief intervention to increase the motivation of clients to seek the health information of smoking and its treatment, and therefore, increase the willingness of quitting.
5As (ask, assess, advice, assist and arrange) is a brief intervention to increase the motivation of the patient with addictive behavior (DiClemente, Delahanty, Kofeldt, Dixon, Goldberg & Lucksted, 2011, p. 261). The first step is to ask the client’s smoking behavior and obtain the basic information about the client. Secondly, the readiness and motivation of clients to quit smoking will be assessed. In this step, stages of change model is a good tool to assess the motivation of client. Then, nurses can deliver the advice to the clients about the pros and cons of health on smoking followed by provision of the effective tips for clients to quit smoking. Fourthly, assist the clients to increase the motivation about quitting smoking and encourage patient to quit smoking. Lastly, the nurses should arrange the follow-up program to provide further support (Dawson, Noller & Skinner, 2013, p. 132; Scanlon, 2006, p. 25 – 26). A study conducted 5As intervention at the mental health community center to the patients with smoking behavior in the community. They found following the implementation of 5As, the rate of tobacco use decreased and more people quit smoking (Dixon et al., 2009). Therefore, 5As is an effective brief intervention to assist clients to quit smoking through enhancing their motivations and providing necessary support.
Nurses are the most important health education provider, who delivers education to the clients. The research showed that good health education program can increase the smoking caseation rate. Health education can provide the impacts on health and lead to the change the attitude of using cigarette (Salaudeen, Musa, Akande & Bolarinwa, 2011, p. 217). Internet is a very useful tool to enhance the effectiveness of health education and promotion. According to Dijk, Nooijer, Heinrich and Vries (2007, p. 122), they found out that the knowledge of tobacco cessation will be delivered better through the internet to the clients. The internet is the preferred education method of adolescents and teenagers. The interviewer indicated that the web site contains the colorful pictures and interesting animation which will increase the motivation to learn and understand information of quitting smoking and also stimulate the client to take action. Therefore, the health education delivery through the internet is a good intervention to spread the health information and increase the health literacy of the clients.
The sustainable strategy to the incident
In this incident, motivational interviewing is the most sustainable brief intervention for Mr. C to improve health literacy and result in quitting smoking. Mr. C had noticed that he has some symptoms such as shortness of breath and productive cough which impact his health condition. However, he is still considering the benefits that he gets from smoking including relieve the stress and anxiety and the social tool to maintain the relationship with peers and collogues. He is ambivalence about take action to change. Therefore, nurses can use motivational interviewing to assist client to evaluate the pons and cons of quitting smoking. Encourage patient to express his idea and identify the barrier of quitting smoking. In addition, nurses can assist the client to resolve the ambivalence and difficulties which lead to higher motivation to quit smoking.
In this stage, there is no apparent health problem on Mr. C, therefore, he did not seriously consider that quitting smoking is an urgent matter for him. During the motivational interviewing, the nurses can provide adverse effects on health to the patient and assist patient to image the healthier future without smoking. Thus, he may seek the related information actively. Motivational interviewing may enhance the client’s motivation to obtain the health information and make the correct decision. Therefore, motivational interviewing is an effective brief intervention which can increase the health literacy and more willing to quit smoking.
Global Health
Dijk, Nooijer, Heinrich and Vries (2007, p. 115) indicated that the clients have smoking behavior will easily influence others’ attitude of smoking. The smoking cessation rate is higher in the family whose member has already quit smoking. Accordingly, the concept of stop smoking can be delivered from individuals to their peers, family even the whole community. When the concept of quit smoking can be deeply installed in everyone’s thought, as a result the occurrence of smoking-related disease will be decrease. The World Health Assembly (2013) pointed out that if the tobacco cessation rate decrease 30%, it will decrease 200 million death related to smoking in 2050. In addition, secondhand smoke can also be decreased. As the result, the overall health of population in the world can be improved. Therefore a single person’s behavior change can be a big contribution of the improvement of the global health.
Conclusion
Smoking is a common unhealthy behavior which will cause adverse effects not only to the individual but also the whole society. Therefore, it is important for nurses to use different approaches to encourage clients to quit smoking. Motivational intervention is a counseling technique which can increase the motivation of the client to take action to give up smoking. 5As is an evidence-based intervention that can help clients to quit smoking through increase willingness and provide essential support. In addition, using internet can increase the effeteness of health education delivery. The incident in this essay is at the contemplation of the stage of change models. Motivational intervention is a sustainable brief intervention for this case which can improve the health literacy and encourage him to stop smoking. The concepts of quitting smoking can delivery from individual to family, peers and community. Consequently, these approaches can improve the health literacy and result in increasing the tobacco cessation rate and improve the health status of global.