Short communication Motivational interviewing versus prescriptive advice for smokers who are not ready to quit Melinda F. Davis a, *, Dan Shapiro a , Richard Windsor b , Patrick Whalen a , Robert Rhode a , Hugh S. Miller a , Lee Sechrest a a University of Arizona, USA b George Washington University Medical Center, USA 1. Introduction Physicians and nurses are uniquely situated to have an important impact on the behavior of smokers. Even minor changes in quit attempts could have a significant effect on patient health. Those who are the farthest away from quitting, however, are the least likely to be urged to quit by health professionals [1,2]. How should health professionals counsel precontemplative or contemplative smokers? The literature on substance abuse and addiction presents two possible approaches; prescriptive or motivational. Prescriptive advice has been the dominant approach for smoking cessation, while motivational interviewing encourages patient participation in health care. In the prescriptive approach, health professionals maintain a firm, authoritative approach with smokers. Some patients want health professionals to take charge and firmly tell them what to do. Research suggests that this is particularly true of older, poorer, and less educated patients [3,4]. Motivational interviewing (MI) seeks to establish a supportive and empathic alliance [5–7]. Ambivalence is acknowledged as part of the normal change process. The patient takes responsibility for major decisions about care [8]. Practice guidelines for health professionals tend to adopt major facets of either the prescriptive or motivational enhancement approaches to smoking cessation [9,10]. 1.1. Review of motivational interviewing Meta-analyses on motivational interviewing have reached different conclusions regarding its effectiveness for smoking reduction [11,12]. We identified eight randomized controlled trials comparing MI against prescriptive advice [13]. While most of Patient Education and Counseling 83 (2011) 129–133 ARTICLE INFO Article history: Received 4 September 2009 Received in revised form 14 April 2010 Accepted 28 April 2010 Keywords: Smoking Stages of change Motivational interviewing Brief advice Treatment effectiveness evaluation Behavior change ABSTRACT Objective: Smokers who are not ready to quit are a very difficult group to treat. Physicians, nurses, and nurse practitioners are in a unique position to encourage patients to quit smoking. However, the best approach to do so is not clear. Methods: A two-group randomized controlled trial with 218 pack-a-day precontemplative and contemplative smokers recruited from the community. The laboratory-based study was designed to simulate outpatient visits to general practitioners. Participants were randomized to a 15-min intervention to compare the effectiveness of brief motivational or prescriptive counseling by a health professional. Thirteen outcome variables included intentions to quit and verbal reports at 1 and 6 months with biological verification. A composite outcome measure was constructed to provide greater power to detect study differences. Results: Approximately 33% of the sample reported at least one 24-h quit period during the 6 months they were followed after the trial. Results suggest that while neither treatment was superior, there were subgroup differences. Participants in the motivational condition were also more likely to respond to follow-up calls. Conclusions and practice implications: Motivational interviewing and prescriptive advice were equally effective for precontemplative and contemplative smokers. Practitioners should use the method that appeals to them. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Psychology, University of Arizona, 1503 E University Blvd., PO Box 210068, Tucson, AZ 85721-0068, USA. Tel.: +1 520 626 7820; fax: +1 520 621 9306. E-mail addresses: mfd@email.arizona.edu, mfd@u.arizona.edu (M.F. Davis), shapiro@psu.edu (D. Shapiro), sphraw@gwumc.edu (R. Windsor), pwhalen@email.arizona.edu (P. Whalen), rrhode@u.arizona.edu (R. Rhode), hmiller1@email.arizona.edu (H.S. Miller), sechest@email.arizona.edu (L. Sechrest). Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2010.04.024