• Paul Aveyard, Terry Lawrence, K K Cheng, Carl Griffin, Emma Croghan, and Carol Johnson.
• Department of Public Health and Epidemiology, University of Birmingham, UK. p.n.aveyard@bham.ac.uk
• Br J Health Psychol. 2006 May 1; 11 (Pt 2): 263-78.

ObjectivesTo examine whether, as predicted by the transtheoretical model (TTM), stage-matched interventions will be more effective than stage-mismatched interventions.DesignRandomized controlled trial of smoking cessation advice to pregnant smokers.MethodsPregnant women currently smoking at 12 weeks gestation were enrolled in a pragmatic three-arm trial of TTM-based interventions to help them stop smoking. One arm constituted standard midwifery advice and a self-help leaflet on stopping smoking, which is generally appropriate for women in preparation. Two arms were TTM-based. Differences in positive movement in stage towards quitting from enrolment to 30 weeks gestation and 10 days post-partum were calculated for each arm of the trial. We then examined whether, as predicted from the TTM, the relative benefit of the TTM-based intervention was greater for women in precontemplation and contemplation, for whom the control intervention was stage-mismatched, than for women in preparation, for whom the control intervention was stage-matched.ResultsWomen in the TTM-based arms were statistically significantly more likely to move forward in stage than were women in the control arm. Contrary to the TTM-derived hypothesis, the greater relative benefit of the TTM-based intervention was seen for women in preparation stage at baseline, rather than women in precontemplation and contemplation.ConclusionsThe TTM-based intervention was more effective in stage movement, but this could be due to its greater intensity. The failure to confirm that stage-matching was important casts doubt on the validity of the TTM in explaining smoking cessation behaviour in pregnancy.

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