Adölesanlarda sigara içme davranışını değiştirmede motivasyon görüşmelerinin etkisi
The effect of motivational interviewing to change smoking behavior in adolescent
Yazar: SAİME EROL
Danışman: PROF. DR. SEMRA ERDOĞAN
İstanbul Üniversitesi / Sağlık Bilimleri Enstitüsü / Halk Sağlığı Hemşireliği Ana Bilim Dalı
Derece: Doktora, 2005
Konu: Halk Sağlığı = Public Health

Özet:
SUMMARY Smoking is still a major public health problem both in our country and around the world. Younger children start smoking everyday. Nurses, particularly those working at schools, have significant roles and opportunities in planning and applying appropriate interventions aimed at behavioral changes and health risk behavior definitions for the adolescent population. Many disciplines including nursing and non-nursing professions have started using the Transtheoretic Model (TTM), which has been developed in light of studies by James Prochaska and CarloDiclemente (1982) within the past few years, to facilitate behavioral changes. This research uses the qusiexperimental research design in order to define the effectiveness of motivational interviews carried out according to Transtheoretic Model's (TTM) behavioral change stages in changing smoking behavior in adolescents. In addition, scales that structure the TTM and that are to be used for the first time in Turkey have been adapted to the Turkish language and culture via methodological studies. The scales are: (1) Smoking; Poecess Definition Scale (PDS), (2) Self-efficacy Scale (SES), (3) Temptation Items for Smoking Scale (TIFS) (3) Decisional Balance Scale (DBS). The study sample comprised sixty first and second year students, who were at the contemplation and preparation periods of change, who received similar scores from TTM scales and who had similar levels of smoking addiction. The students were divided into motivation (n=30) and education (n=30) groups by simple randomized numbers table. Members of one group were offered motivational behaviors, and those in the other group were given health education. At the end of the study, no statistically significant difference was found in TTM scales of motivational and educational methods (PDS, SES, TIS, DBS) for the third (p= 0.22, p= 0.77, p=0.84, p= 0.46, respectively) and sixth months (p= 0.91, p= 0.14, p= 0.55, p= 0.1 1, respectively). However, the following subscale perception score averages 121were found higher in the motivation group then the education group in the third month: "gaining individual independence" subscale of PDS (p= 0.04), "Being able to cope with the habit strength" of SES (p= 0.02), and "damages caused by smoking'' of DBS (p= 0.02). These differences demonstrated that students in the motivation group have had a better progress in the stages of change. The advantages in these subscales in the motivation group diminished in the sixth month after the interviews had been stopped. In the sixth month, "being able to cope with weight control" subscale of PDS score average decreased both in the motivation and education groups (p=0.04). Temptation Items scale's "Weight control" subscale score average did not change in the motivation group but increased in the education group (p=0.01). "Negative sensation" subscale of the Temptation Items scale increased in the motivation group (p= 0.04). "Contribution to Socialization" subscale of the Decisional Balance scale increased in both group, being less in the motivation group (p=0.000). The effectiveness of both methods in smoking cessation was not significant in the third (p= 0.055) and sixth months (p= 0.544). However; - Measurements done in the third month demonstrated that 8 students in the motivation group, and 3 students in the education group had quitted smoking. - It was seen during the measurements done in the sixth month that 12 students in the motivation group and, 8 students in the education group had quitted smoking. Transteoretik Model, is an appropriate tool that controls smoking behavior change of an individual with sensitive measurements. It gives information in planning nursing initiatives, in assessing the effectiveness of the initiatives, and the level with which the individual has changed, and provides a basis for future regulations. 122

Abstract:
SUMMARY Smoking is still a major public health problem both in our country and around the world. Younger children start smoking everyday. Nurses, particularly those working at schools, have significant roles and opportunities in planning and applying appropriate interventions aimed at behavioral changes and health risk behavior definitions for the adolescent population. Many disciplines including nursing and non-nursing professions have started using the Transtheoretic Model (TTM), which has been developed in light of studies by James Prochaska and CarloDiclemente (1982) within the past few years, to facilitate behavioral changes. This research uses the qusiexperimental research design in order to define the effectiveness of motivational interviews carried out according to Transtheoretic Model's (TTM) behavioral change stages in changing smoking behavior in adolescents. In addition, scales that structure the TTM and that are to be used for the first time in Turkey have been adapted to the Turkish language and culture via methodological studies. The scales are: (1) Smoking; Poecess Definition Scale (PDS), (2) Self-efficacy Scale (SES), (3) Temptation Items for Smoking Scale (TIFS) (3) Decisional Balance Scale (DBS). The study sample comprised sixty first and second year students, who were at the contemplation and preparation periods of change, who received similar scores from TTM scales and who had similar levels of smoking addiction. The students were divided into motivation (n=30) and education (n=30) groups by simple randomized numbers table. Members of one group were offered motivational behaviors, and those in the other group were given health education. At the end of the study, no statistically significant difference was found in TTM scales of motivational and educational methods (PDS, SES, TIS, DBS) for the third (p= 0.22, p= 0.77, p=0.84, p= 0.46, respectively) and sixth months (p= 0.91, p= 0.14, p= 0.55, p= 0.1 1, respectively). However, the following subscale perception score averages 121were found higher in the motivation group then the education group in the third month: "gaining individual independence" subscale of PDS (p= 0.04), "Being able to cope with the habit strength" of SES (p= 0.02), and "damages caused by smoking'' of DBS (p= 0.02). These differences demonstrated that students in the motivation group have had a better progress in the stages of change. The advantages in these subscales in the motivation group diminished in the sixth month after the interviews had been stopped. In the sixth month, "being able to cope with weight control" subscale of PDS score average decreased both in the motivation and education groups (p=0.04). Temptation Items scale's "Weight control" subscale score average did not change in the motivation group but increased in the education group (p=0.01). "Negative sensation" subscale of the Temptation Items scale increased in the motivation group (p= 0.04). "Contribution to Socialization" subscale of the Decisional Balance scale increased in both group, being less in the motivation group (p=0.000). The effectiveness of both methods in smoking cessation was not significant in the third (p= 0.055) and sixth months (p= 0.544). However; - Measurements done in the third month demonstrated that 8 students in the motivation group, and 3 students in the education group had quitted smoking. - It was seen during the measurements done in the sixth month that 12 students in the motivation group and, 8 students in the education group had quitted smoking. Transteoretik Model, is an appropriate tool that controls smoking behavior change of an individual with sensitive measurements. It gives information in planning nursing initiatives, in assessing the effectiveness of the initiatives, and the level with which the individual has changed, and provides a basis for future regulations. 122