Versions Compared


  • This line was added.
  • This line was removed.
  • Formatting was changed.

Index |  Introduction |  Smoking-Aware Practice |  Quitlines |  Supporting quit attempts
Pharmacotherapies |  Alternative Approaches |  Special Groups |  References



The primary care health professional can help to support a smoker before a quit attempt, during the quit attempt, after a successful quit attempt and during any relapse.[43][44] An understanding of the different stages that people go through when they undergo any behavioural change can help clinicians ask the right questions at the right time, though it is important to appreciate that people do not necessarily move through the stages in sequence. Moreover, peoples' behaviour especially when influenced by addiction is hard to plan.

The stages of the 'cycle of change' (pre-contemplation, contemplation, determination, action, relapse and maintenance) may all be reflected during the process of considering giving up smoking to succeeding in quitting smoking or, indeed, relapsing and starting smoking again.[45] Many smokers who succeed in giving up smoking in the short-term, relapse, and support at this stage may be crucial in persuading a relapsed smoker to try and quit smoking again.

The model may help the clinician to work with smokers over time and support them on their terms. The aim is thus not to achieve cessation there and then but to move the patient closer to a quit attempt. Some smokers move quickly through the stages, in others the process may take years. The process is dynamic and the primary care team must always be positive and offer.[46]

How to use the Cycle of Change to help smokers quit

How to use the Five As to guide smokers through their quit attempt

Download a desktop helper for brief interventions to encourage smoking cessation 

An example of scripts for motivational interviewing can be found at

National Centre for Smoking Cessation Training (NCSST) Very Brief Advice online training

Resources from WHO including training manual for primary care including 5As - for all income settings. Published 2013




Teach the Teacher manual from WHO using adult learning principles: recommended.

Global Bridges pages