Table 4. Main themes and conclusions relating to UA quitting in the 11 studies and their contribution to the themes and concepts reported in this review.
| Source paper | Main themes relating to UA quitting reported in this paper | Main conclusions relating to UA quitting reported in this paper | Concepts and themes reported in this review a | Conceptual contribution to this review b |
|---|---|---|---|---|
| Baer et al. 1977 [28] | (1) Pronounced differences in the techniques used by participants to quit; (2) Challenge to self and motivation appeared as a common combination of techniques, as did motivation and self-derogation | Most respondents used multiple techniques to quit, but there was no systematic clustering of these methods | Motivation—equivalent to one’s reason for quitting; Willpower—tautologous, ambiguous; Willpower—a personal quality or trait; Commitment—being serious or resolute | Medium |
| Solheim 1989 [29] | (1) Socio-environmental factors affect cessation (e.g. interactions with family, friends and health professionals); (2) Thoughts pre-quitting primarily negative (e.g. assessing benefits and consequences of smoking, or process of quitting). Thoughts post-quitting primarily positive; (3) Emotions pre-quitting included guilt, fear, anger, and disquiet. Emotions post-quitting are positive, but also included loss and resentment; (4) Motivational response included decision-making, self-determinism, taking action, messages to oneself | Smoking cessation is a process that begins before an individual stops smoking; characteristic thought processes and emotions occur before and after cessation; actions to aid cessation are unique to each individual; family and friends are influential; factors may be interactive, occur simultaneously and may be cumulative in their effect on the cessation process | Motivation—equivalent to one’s reason for quitting | Low |
| Thompson 1995 [30] | (1) Evolving commitment to health and personal growth; (2) The effect of a smoke-free environment; (3) The impact of anti-smoking education; (4) Changing conceptualisation of smoking | Anti-smoking education, coupled with smoke-free environment, augments the awareness of the effects of smoking and directly impacts on one’s conceptualisation of smoking | Willpower—a strategy; Commitment—being serious or resolute; Commitment— can be cumulative | Medium |
| Mariezcurrena 1996 [31] | (1) Triggers precipitating or helping quitting; (2) Coping strategies used to quit; (3) Advice given by ex-smokers about quitting (successful quitting required decision-making, wanting to stop, being determined, and belief in oneself) | Participants attributed their change to their own effort; making the decision to stop was the most frequent trigger to stopping; it was related to fear, health concerns and feeling of loss of control | Motivation—equivalent to one’s reason for quitting; Commitment—being serious or resolute | Low |
| Stewart 1999 [32] | (1) Contemplation: allows for goal setting; mental preparation; knowledge of addiction; (2) Decision to quit: unique decision; allows for no excuses; willpower; no desire to smoke; (3) Relapse: creates knowledge of pitfalls; less commitment in previous attempt; life events cannot overwhelm willpower; no moderation; (4) Environment: contributed to smoking; motivation; attitude towards other smokers; (5) Process of cessation: multiple techniques; point of no return; dreams | Participants used multiple techniques to quit; most had relapsed and used this as motivation to continue trying to quit | Motivation—equivalent to one’s reasons for quitting; Motivation—not a prerequisite for quitting; Willpower—tautologous, ambiguous; Willpower—a method; Willpower—a personal quality or trait; Commitment— being serious or resolute; Commitment—can be tentative or provisional; Commitment—can be cumulative | High |
| Abdullah and Ho 2006 [33] | Themes (importance of quitting, perceived barriers to quitting, perceived benefits of quitting, reasons to quit) were general and reported little specifically about UA quitting | Decision to quit smoking was not an urgent or important decision; belief that they could quit at any time with little difficulty; willpower and determination can help quitting | Willpower—tautologous, ambiguous; Willpower—a personal quality or trait | Low |
| Nichter et al. 2007 [34] | (1) Reasons for quitting (for the baby, social pressure, fear, appeasing family); (2) Moral authority to control environments in which smoking is normative; (3) Smoking is a personal responsibility and quitting is a matter of personal choice | Successful quitters had a strong sense of moral identity as a mother; concern for effect of smoking on foetus; social networks had an important impact on woman’s ability to quit; lack of control of environment affected quitting success | Commitment—being serious or resolute | Low |
| Ogden and Hills 2008 [35] | (1) The role of life crises as specific triggers to initial behaviour change; (2) Key sustaining conditions (a disruption of function; a reduction in choice; behavioural model of causes and solutions) which allowed the initial change in behaviour to be translated into a longer term change in lifestyle | If a person no longer benefits from the behaviour, finds that they are fewer opportunities to carry out the unhealthy behaviour and believes that the behaviour was the cause of his or her problems, then an initial change in behaviour is more likely to be translated into a behaviour change in the longer term; central to all themes was a process of reinvention and a shift toward a new healthier individual | Willpower— a method | Low |
| Bottorff et al. 2009 [36] | (1) Cold turkey storyline framed quitting smoking as a snap decision with no need for support; (2) The ‘baby as the patch’ storyline dramatised how the baby displaced the need to smoke, increased motivation for cessation and enhanced success | Common to all storylines was the men’s reluctance to rely on smoking cessation resources; instead self-reliance, willpower, autonomy figured more prominently in the narratives | Motivation—equivalent to one’s reasons for quitting; Willpower—tautologous, ambiguous; Willpower—a personal quality or trait | Medium |
| Murray et al. 2010 [37] | (1) The majority of spontaneous quitters had not used any support; (2) Reasons for not using support included lack of time to access support, lack of knowledge about support available, belief general practitioner would not be receptive to offering smoking cessation support, a belief they should quit on own | The majority of spontaneous quit attempts were made without the use of support | Commitment—being serious or resolute | Low |
| Medbø et al. 2011 [38] | (1) Approaching a decision to stop: reflection on the consequences of smoking; ambivalence hardens into resolution and the smoker waited for an appropriate opportunity to quit; (2) The actual stopping: many stopped suddenly and unplanned as a result of accidental circumstances; no clear decision-making, stopping without visible internal struggle or resolution; (3) Quitting was easier than expected | Patient preferences for quitting should be explored; some smokers may stop unplanned with little motivation; GPs interest in the smoking narrative may sometimes be enough to encourage cessation | Motivation—not a prerequisite for quitting; Commitment—can be tentative or provisional | Low |
a Includes only the themes and concepts reported in this review, not all of the themes and concepts that were coded and mapped (see Fig 2 for full range of concepts).
b Conceptual contribution to review: low: contributed to <3 themes; medium: contributed to ≥3–5 themes; high: contributed to ≥6 themes (see Table 5 for more detail on how individual studies contributed conceptually to the review).