Decisional balance proportion: Quantifying qualitative data to represent motivation to change among treatment-seeking smokers

Abstract

This study tested a new measure of motivation to change as a predictor of smoking behavior following smoking cessation treatment. Participants were adult, regular smokers ( N = 191) who took part in a randomized smoking cessation trial in southwestern Germany ( Batra et al., 2010). Participants completed smoking and psychological self-report measures before and after a 6-week smoking cessation treatment. Among these measures, the open-ended decisional balance worksheet elicited participant-generated pros and cons of smoking versus abstinence. Counts of the pros and cons were combined into the decisional balance proportion (DBP), which reflected participants’ current balance towards smoking behavior change. Additional smoking assessments were conducted up to the 12-month follow-up. After controlling for group effects and baseline smoking, DBP change scores (posttreatment–pretreatment) reflecting greater movement towards change during treatment predicted time to first smoking lapse as well as abstinence up to the 12-month follow-up. Higher DBP change scores also predicted lower frequency and intensity of smoking lapses during the 12-month follow-up. Findings indicated that participant-generated, qualitative data from a decisional balance worksheet can be quantified to produce a valid measure of motivation to change among smokers. This measure can inform intervention content and may potentially be used to match smokers to appropriate treatments.