# Situation: The public health nurse of a Rural Health Unit (RHU) runs a tobacco and alcohol program for tricycle drivers and factory workers in the municipality. A 44-year-old tricycle driver smokes a pack of cigarettes a day. He says he knows smoking is bad for him and may quit "someday," but he has no intention of quitting within the next 6 months. Which approach fits his stage of change at this visit?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a Rural Health Unit (RHU) runs a tobacco and alcohol program for tricycle drivers and factory workers in the municipality.

A 44-year-old tricycle driver smokes a pack of cigarettes a day. He says he knows smoking is bad for him and may quit "someday," but he has no intention of quitting within the next 6 months. Which approach fits his stage of change at this visit?

## 보기

1. Link his smoking to his own health and his family's **✔ 정답**
2. Help him choose a quit date within the next month
3. Discuss the pros and cons he sees in quitting
4. Teach him ways to cope with urges and avoid relapse

**정답: 1**

## 해설

Knowing that smoking is harmful does not move a client out of precontemplation; the stage is defined by intention, and he has no intention to quit within the next 6 months. Precontemplation calls for raising awareness and personalizing the risk. Decisional balance fits contemplation, a quit date fits preparation, and relapse prevention fits action and maintenance.

## 심화 해설

The client’s statement contains the key cue: he acknowledges smoking is harmful but has no plan to quit within the next 6 months. In the transtheoretical model, this places him in the precontemplation stage. Stage assignment is based on intention and a defined time frame, not on knowledge or awareness of harm. A person can fully understand that a behavior is dangerous and still remain in precontemplation because the defining feature is the absence of intention to act within 6 months.

In precontemplation, the appropriate nursing approach is to raise awareness and personalize the risk, not to push for immediate action. The client already knows smoking is bad in a general sense, but he has not connected that risk to his own life, his daily symptoms, his role as a driver, or his family. Linking smoking to his own health and his family’s health is the stage-matched intervention because it helps him begin to see the problem as personally relevant. This is the first step toward moving from “I may quit someday” to “I am thinking about quitting.”

The other options represent interventions matched to later stages. Watch out! Discussing pros and cons is a decisional balance exercise that fits contemplation, when the person is already intending to change within 6 months but feels ambivalent. Helping the client choose a quit date within the next month fits preparation, when intention has turned into a concrete plan. Teaching coping skills and relapse prevention fits action and maintenance, when the person has already stopped smoking and is working to sustain the change.

The transtheoretical model describes change as a progression through stages, and individuals often recycle through these stages several times before achieving stable cessation [2]. Across multiple health behaviors, consistent patterns have been found between the perceived pros and cons of changing and the stage of change [1]. This means that stage-matched interventions are more likely to be effective than stage-mismatched ones. A randomized controlled trial of smoking cessation in pregnant women tested this principle directly by comparing stage-matched and stage-mismatched interventions [3]. The underlying logic is that asking a precontemplator to set a quit date or practice relapse prevention is premature because the person has not yet decided that quitting is worth doing.

The table below summarizes how each stage is defined and what nursing approach fits that stage.

| Stage | Defining feature | Stage-matched nursing approach |
| --- | --- | --- |
| Precontemplation | No intention to change within 6 months | Raise awareness, personalize risk, link behavior to own health and family |
| Contemplation | Intends to change within 6 months, ambivalent | Explore pros and cons, support decisional balance |
| Preparation | Intends to act within 30 days, has a plan | Set a quit date, remove triggers, build support |
| Action | Has changed behavior for less than 6 months | Teach coping skills, reinforce success, manage urges |
| Maintenance | Has maintained change for 6 months or more | Prevent relapse, plan for high-risk situations |

Key point! The stage is determined by intention and time frame, not by knowledge. A client who says “I know it is bad, but I am not ready to quit” is in precontemplation, and the nurse’s first job is to help the client see why this matters for him personally. In a community setting such as a Rural Health Unit program for tricycle drivers and factory workers, stage-specific interventions are especially important because many participants may be in precontemplation and will not respond to action-oriented advice . The correct response at this visit is to link his smoking to his own health and his family’s health, which begins the process of moving him toward contemplation.References (research sources)

- [1]The transtheoretical model of health behavior change.Research articleProchaska JO, Velicer WF (1997) · DOI: 10.4278/0890-1171-12.1.38

- [2]In search of how people change. Applications to addictive behaviors.Research articleProchaska JO, DiClemente CC, Norcross JC (1992) · DOI: 10.1037//0003-066x.47.9.1102

- [3]A randomized controlled trial of smoking cessation for pregnant women to test the effect of a transtheoretical model-based intervention on movement in stage and interaction with baseline stage.RCT/clinical trialAveyard P, Lawrence T, Cheng KK, Griffin C, Croghan E, Johnson C (2006) · DOI: 10.1348/135910705X52534

## 임상 시나리오

Stage-Matched Smoking Cessation CounselingApplying the Transtheoretical Model in Primary Care
A client who acknowledges harm but has no intention to quit within 6 months is in precontemplation. The priority intervention is to personalize the risk—connect smoking to his own health, symptoms, and family—not to push for immediate action.

Stage assignment is based on intention and time frame, not knowledge. A client can fully understand smoking is dangerous and still be precontemplative. Match the intervention to the stage: decisional balance for contemplation, quit date setting for preparation, and coping skills for action/maintenance.

CautionDo not jump to action-oriented counseling (quit dates, coping strategies) before the client has moved from "someday" to "thinking about quitting." Premature action planning can increase resistance and disengagement.

## 핵심 개념

- **Precontemplation** — The stage of change in which a person has no intention to change a behavior within the next 6 months, regardless of their awareness of the risks.
- **Transtheoretical Model** — A model of intentional change that describes five stages: precontemplation, contemplation, preparation, action, and maintenance. Stage assignment is based on intention and time frame.
- **Decisional Balance** — A cognitive process of weighing the pros and cons of a behavior change, typically used in the contemplation stage to resolve ambivalence.
- **Preparation Stage** — The stage of change in which a person intends to take action within the immediate future (e.g., within 1 month) and may have already made small changes or set a quit date.
- **Personalizing Risk** — A precontemplation-stage strategy that helps a client connect a general health risk to their own life, symptoms, roles, or family, thereby increasing perceived relevance.

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