Open Access Highly Accessed Research article

Eating the elephant whole or in slices: views of participants in a smoking cessation intervention trial on multiple behaviour changes as sequential or concurrent tasks

Preethi Koshy2*, Mhairi Mackenzie1, Wilma Leslie2, Mike Lean2 and Catherine Hankey2

Author Affiliations

1 Urban Studies, School of Social & Political Sciences/Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RS, UK

2 Human Nutrition, School of Medicine, University of Glasgow, Glasgow, G4 0SF, UK

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BMC Public Health 2012, 12:500  doi:10.1186/1471-2458-12-500

Published: 3 July 2012



This paper explores smoking cessation participants’ perceptions of attempting weight management alongside smoking cessation within the context of a health improvement intervention implemented in Glasgow, Scotland.


One hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and randomised to intervention, receiving dietary advice, or to control groups. The primary outcome of the study was to determine the % change in body weight. Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 (during the intervention) and 24 (at the end of the intervention). The current paper, though predominantly qualitative, links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better understanding of the mediators influencing multiple behaviour change.


Our findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle, and hence attempt behaviour changes concurrently, may be at comparative advantage in positively achieving dual outcomes.


These findings highlight the need to assess participants’ preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change. Further testing of this hypothesis is warranted.

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