title: A new method for describing smokers' consulting behaviours which indicate their motivation to stop smoking: an exploration of validity and reliability.
abstract: BACKGROUND
  Smokers vary in their readiness to try stopping smoking, but there currently are no objective tools for identifying smokers' consulting behaviours which indicate their level of motivation to try stopping smoking.
  
  
  OBJECTIVE
  The aim of this study was to investigate the construct validity and inter-observer reliability of the Smokers' Motivation Code (SMC).
  
  
  METHODS
  General practice consultations between 29 different Leicestershire GPs and their patients were video-recorded. In 47 consultations, regular or occasional smokers discussed smoking with their GPs and their consulting behaviour was coded using the SMC. The reliability of three different observers' codings was investigated. Construct validity was also investigated by comparing smokers' consulting behaviours coded using the SMC with measures of motivation to stop smoking recorded on pre-consultation questionnaires.
  
  
  RESULTS
  Two pairs of observers achieved good reliability when using the SMC to code smokers' consulting behaviours during a subset of 11 video-recorded consultations. For readiness behaviours (indicating motivation to stop smoking), kappas were 0.82 and 0.65, and for resistance behaviours (indicating little motivation to stop smoking), kappas were 0.74 and 1.0. For the 37 consultations attended by regular smokers, complete pre-consultation questionnaires were obtained. Smokers displaying readiness behaviours were significantly more likely than others to report having tried to stop in the past year, thinking about or trying to stop and to agree that their health would improve if they stopped smoking. Smokers displaying resistant behaviours were significantly less likely to report thinking about stopping/trying to stop smoking.
  
  
  CONCLUSIONS
  We have provided some evidence to support the construct validity and inter-observer reliability of the SMC and have identified some consulting behaviours which might indicate smokers' motivation to stop smoking. Further work is needed to determine whether smokers' consulting behaviour can be used to predict future quit attempts.
authors.affiliation: Division of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, UK. tim.coleman@nottingham.ac.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Coleman
authors.forename: Keith
authors.initials: K
authors.lastname: Stevenson
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012307:Risk Factors; D016540:Smoking Cessation / Q000523:psychology*; D014743:Videotape Recording