Review of Worksheets for Creating a Quit Plan

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This section reports on participants' impressions of the worksheets associated with the Creating a quit plan section, including their experiences in completing the worksheets.

Relevant worksheets include:

• Confidence Questiomiaire (to Create Your Difficulty Ladder)

• Daily Record (completed by former smokers only)

• Tracking Form (completed by CUITent smokers only)

• Rewards List

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Positive Impression of Worksheets, Seen to Foster/Encourage Reflection

OveraIl, participants reacted positively, and in sorne instances very positively, to the worksheets associated with this section. There was a general consensus that the worksheets were useful, at least in the aggregate. However, sorne participants felt that sorne worksheets were much more useful than others. As weIl, sorne people said that while the worksheets were perhaps not very useful to them personaIly, they would probably be useful to others, particularly smokers who have taken the decision to quit but have not yet done so.

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In explaining their overall positive impression, most participants made reference to the fact that the worksheets encourage or foster reflection. This has the effect of raising awareness or making one conscious of such things as smoking patterns, the number or frequency of cigarettes smoked, the 'types' of cigarettes smoked (e.g. cigarettes with a

'purpose' vs. those smoked out of boredom), risks, cravings, etc. A few participants felt

that the worksheets allow one to begin to take control by developing strategies to deal with their smoking-related behaviour based on increased understanding of their smoking behaviour. One participant described the worksheets as serving a purpose and having an effect similar to a diary.

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Sorne participants described the worksheets as clear or straightforward, and easy to complete. On the more critical side, a few noted that there is sorne repetition in the worksheets. While one participant felt that such repetition can help to add emphasis or

"drive a point home", others were annoyed or frustrated by repetition in the worksheets.

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Worksheets Well Linked to Section Content

There was a general consensus that the worksheets are weIl integrated with the information provided in this section (i.e. that they complement one another). A few participants elaborated on what they meant by this by noting that the worksheets address and deal with issues discussed in the section and that the links to the worksheets appear at appropriate places throughout the section. Despite the foregoing, it was suggested that while the worksheets are weIl integrated with the information, it would help if there were

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sorne sort of introductory note clarifying the relationship between the text and the

worksheets.

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Feedbaek on Specifie Worksheets Generally Positive, Sorne Seen to be Less Useful Overall, participants tended to have generally favourable or positive impressions of the

various worksheets. Asked for their overall impression of each worksheet, they tended to

comment on each one's perceived usefulness. In doing so, most made it clear that they rated sorne as better or more useful than others (see discussion of specifie worksheets for more detail). The most frequently voiced overall impression related to specifie worksheets had to do with the perceived similarity or duplication between the 'Motivation' and 'Associations' worksheets. Almost half the participants drew attention to this when asked for their overall impression of these two worksheets.

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Purpose ofWorksheets Generally Understood

With few exceptions, participants said they clearly understood the purpose of the various worksheets, what they were being asked to do, and why they were being asked to do it.

However, sorne worksheets were identified by a few participants as lacking clarity or involving confusion. These included 'Motivation', 'Associations', 'Rewards List', and 'Daily Record'. While relatively few participants described any of these worksheets as unclear, those who did tended to focus on the 'Motivation' and/or 'Associations' worksheets. Their questions included:

• Why do they ask about the long-term advantages or good things about smoking?

• Why ask about the long-term disadvantages of quitting?

• What do they mean by positive or negative "associations" with smoking or quitting?

• What's the difference between these two worksheets?

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A couple of participants described the instructions for the 'Daily Record' as unc1ear.

SpecificaIly, they pointed to the table that is provided as an example of information that can be collected. It was not c1ear to them whether in completing their form they were to deal with each of the questions in a separate cell or all of them within the sarne cell. They suspected the latter but since the exarnple table places each question in a separate cell they were not entirely clear about this. As well, one participant was unc1ear whether users needed to complete the table going across or up and down, since sorne of the questions in the table were the sarne in each column (e.g. "what were you saying to yourself?").

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FinaIly, a couple of participants said they did not understand the purpose of sorne of the questioris asked in the 'Rewards List'. They inc1uded questions 6 (What makes you feel good?), 9 (What do you enjoy doing?), Il (Who do you like to spend time with?), and 13 (Are there any movies you would like to see?).

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W orksheets Genetally Seen to be Easy to Complete, Sorne Diffieulties Cited

Participants had no real difficulties completing any of the worksheets. A number even volunteered that the worksheets were easy or straightforward. Moreover, their ability to successfully complete the worksheets was confirmed by a review of the completed worksheets undertaken by Phoenix researchers.

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^N evertheless, sorne participants did identify difficulties completing specifie worksheets.

These difficulties fell into four categories: difficulty conceiving or conceptualizing, difficulty quantifying, cumbersome nature of the activity, and difficulty understanding what was being asked (see above for the latter).

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• Difficulty conceiving or conceptualizing: A few participants said they had sorne di ffi cult y providing responses or answers to things they had not thought of before.

They were referring specifically to the 'Motivation' and 'Associations' worksheets, which asked them questions they had not previously considered, such as the 'short and long-term disadvantages of quitting' and the 'long-term good things about smoking'.

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• Difficulty quantifying: A few found it difficult to quantify or rate certain things asked for in various worksheets. This included describing their mood and rating the extent to which they needed a cigarette in the 'Tracking Form', quantifying cravings as asked in the 'Graph', and rating confidence to resist the urge to smoke in various situations, as asked in the 'Confidence Questionnaire'.

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• Cumbersome nature of activity: A couple of participants described completing the 'Daily Record' as difficult because it was cumbersome to complete an entry for each craving or trigger.

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Usefulness of Specifie Worksheets Varies

As noted, participants' impressions of the different worksheets tended to vary in terms of their usefulness in helping them develop strategies for quitting smoking or remaining smoke- free. That is, they tended to distinguish between the various worksheets, viewing sorne as more useful than others. A majority of participants described most of these worksheets as useful, but those most likely to be described as such included the 'Tracking Form', 'Rewards List', and 'Confidence Questionnaire', while those less likely to be described as such included 'Associations' and the 'Graph'. A more detailed and fulsome description of the perceived usefulness of each worksheet is provided below.

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The various worksheets are presented below, in approximate order of their perceived usefulness, from the most useful to the least.

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Tracking Form:

Virtually all of the CUITent smokers who completed the 'Tracking Form' described it as useful, and many as very useful. Sorne volunteered that it was the most useful of the worksheets. Sorne said it enabled them to become aware of how much they smoked in a way they had not been aware before. Not only could they quantify the number of

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cigarettes smoked but they could see the actual time lapse between cigarettes which surprised or shocked sorne of them. Others said that the tracking sheet allowed them to notice patterns in their smoking behaviour (i.e. time, place, company, mood) and this would help them develop a plan to help them respond in a pro active way.

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Confidence Questionnaire:

Most participants described the 'Confidence Questionnaire' (including its conversion into a 'Difficulty Ladder) as useful. Reasons for its usefulness include the ability to quantify risk and proceed in an incremental way from situations that are easiest to ones that are more difficult. It was also noted that the worksheet allows users to identify specifie situations that act as triggers. A few participants described it as not very useful to them, though it might be to others. These tended to be non-smokers who said they were now beyond the stage of feeling cravings and so were confident in all situations. One was a smoker who said that her smoking patterns coincide with specifie times of day, not specifie situations, so this worksheet was not useful.

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Rewards List:

Participants were more likely than not to describe this worksheet as useful. Sorne of those who found it useful focused on the financial motivation underlying sorne ofthe questions, while others focused more generally on rewards as a motivation to quit smoking. A few participants found it useful because, beyond the rewards, it helped identify things one could be doing instead of smoking. The few who did not find it useful said they were not motivated by rewards as a reason to stop smoking or to remain smoke-free.

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Most former smokers found this worksheet to be useful because it allowed them to understand their urges to smoke or cravings in such as way as to be able to control them or at least understand why they might slip up. However, sorne viewed it as not very useful precisely because they felt they could control their urges or because the need to control them was becoming less difficult each day. In that sense, a few said that the usefulness of this worksheet depends on where one is in terms of controlling urges. It can be quite useful to someone who has just quit smoking, but becomes less useful withtime.

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Graph:

Participants were divided over the usefulness of the 'Graph', with similar numbers describing it useful and not useful. Those describing it as useful focused on the ability to identify patterns in their weekly smoking behaviour or trends from week to week. Those who described it as not useful tended to see it as a less elaborate and useful version of the 'Tracking Form'. A few added that the graph is not detailed enough to develop a strategy since it is only a line on a paper that indicates a tendency. Sorne non-smokers said the graph was not very useful because they do not have very many cravings br do not have them every day, so there is no real point in tracking them. Another non-smoker said it is difficult to track cravings. Finally, a few smokers said that their smoking patterns are set and they know them well so there is no need for the 'Graph'.

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Motivation/Associations:

These two worksheets tended to be associated or discussed together. Participants were most likely to question the relevance or usefulness of having both of these worksheets, primarily because they tended to see them as doing or asking for similar things (i.e. at least one of them being redundant). In addition to this, sorne participants felt that there was nothing particularly useful about asking people about the good things about smoking or long-term disadvantages of quitting. According to them, the focus should be on the disadvantages of smoking. Not only was there perceived duplication between the purpose and approach of the two worksheets, it was also noted that there is virtual duplication within each worksheet (e.g. good things about quitting tend to be mirror images [i.e. in reverse] of bad things about smoking; focus on both short-term and long-term). A few participants viewed these worksheets as a bit trite or simplistic due to the questions they ask of users. As well, a few non-smokers added that these two worksheets are more suited for smokers who have just decided to quit smoking and may profit more from reflecting on these issues. That said, a number of participants (though a minority) described both worksheets as useful ( il few said very useful) because they forced them to think or reflect about things they had not thought of.

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Suggestions for Improvement

Over half the participants made suggestions for improving these worksheets. While numerous suggestions were made, only one was identified by more than a few participants. One-in-five participants suggested clarifying the relationship or difference between the 'Motivations' and 'Association' worksheets. Related suggestions included ad ding instructions to each worksheet, pro vi ding an example of what is meant by 'association', or cutting one of these worksheets altogether.

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Only four suggestions did not pertain to specifie worksheets, but rather to the worksheets in general. One was to make the worksheets more interactive, if possible. This would make them more interesting and perhaps more relevant to each individual. Another was to color code the worksheets to better match them to the information sections that they are linked to. The other two suggestions involved adding new worksheets. One participant suggested a worksheet that would focus on three things: why people began to smoke in the first place, whether they now smoke for the same reasons, and if not, why they continue to smoke. This might somehow be linked to the 'Tracking Form'. Another participant suggested adding something like a 'True or False' questionnaire, which would introduce new or little-known information or ideas to smokers and former smokers.

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All other suggestions related to specifie worksheets and will therefore be assigned to the worksheets to which they pertain.

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Daily Record:

• Clarify the example on how to fill out the form. Currently it gives the impression that each of the questions provided as an example should be discussed in a separate cell. As well, having sorne of the questions in the table being the same in each column (e.g. "what were you saying to yourself?") was a source of confusion that needs clarification.

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• Provide more room to write (i.e. bigger cells) on the worksheet.

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Tracking Form:

• Provide more room to write (i.e. bigger cells) on the worksheet.

• Leave the options for 'mood' more open-ended (i.e. not simply good, bad, or unsure).

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Rewards List:

'All the suggestions regarding the Rewards List involved cutting specifie questions which were characterized as irrelevant. These inc1uded:

• Q.6 (What makes you feel good?).

• Q. 9 (What do you enjoy doing?).

• Q.13 (Are there any movies you would like to see?)

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^Graph:

• Make it more interactive by allowing people to extrapolate their findings for a week (e.g. over a 5-year period).

• Alter the graph in such a way as to allow people to begin any day of the week (i.e.

so that they do not have to begin with Monday). Right now, this is difficult to do and is the source of sorne confusion or annoyance.

• Allow for the cravings to be grouped instead of having to list each one. This would inc1ude the different ~ of cravings one would have (e.g. triggered by people, food, etc.). Break this into a set of groups and have people analyze the groups. Doing this for each craving was described as too labour intensive.

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Motivation:

• Cut the distinction between 'long' and 'short-term'. Have people focus only on advantages and disadvantages.

• Cut the tables dealing with good and bad things about smoking and focus on advantages and disadvantages, which are more concrete distinctions.

• Remove the table dealing with good things about smoking.

• Try to make the tables more difficult to complete. As it is, the focus is likely to be primarily on health and financial considerations.

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Associations:

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• Cut the worksheet altogether.

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Note that the only worksheet in relation to which no suggestions were made was the Confidence Questionnaire.

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Dans le document Health Canada Smoking Cessation Study: (Page 23-29)