Co esponding au ho : Nadia Hani Jahaya
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Beyond ea appeals: Explo ing nos algia-e oked men al simula ion as a pe suasi e
s a egy o smoking cessa ion
Nadia Hani Jahaya *, Mohd Nizam Osman, Jusang Bolong, Rosmiza Bidin and Tham Jen Se n
Facul y o Mode n Languages and Communica ion, Uni e si i Pu a Malaysia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 825-832
Publica ion his o y: Recei ed on 26 Ma ch 2025; e ised on 03 May 2025; accep ed on 06 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1636
Abs ac
This s udy in oduces nos algia-e oked men al simula ion as a compelling s a egy o smoking cessa ion, o e ing a
no el al e na i e o adi ional ea -based app oaches. Men al simula ion, a cogni i e echnique enabling indi iduals o
isualize u u e ou comes, enhances mo i a ion and goal-di ec ed beha iou . When combined wi h nos algia—
emo ionally signi ican memo ies om he pas — his app oach os e s deepe emo ional engagemen and cogni i e
e lec ion, inc easing i s pe suasi e po en ial. Despi e i s p omise, limi ed esea ch has applied nos algia-d i en men al
simula ion in heal h in e en ions. This quali a i e s udy add esses his gap by examining how such in e en ions
in luence smoke s’ a i udes and in en ions o qui . Conduc ed ac oss h ee go e nmen hospi als in Peninsula
Malaysia, he s udy in ol ed smoke s en olled in he Qui Smoking Clinic P og am. Pa icipan s we e assigned o one o
ou g oups: h ee ecei ed nos algia-e oking audio messages— ocused on pas image y, physiological challenges, o
posi i e emo ions—while a con ol g oup ecei ed con en ional heal h wa nings. Na a i e analysis o pa icipan s’
e lec ions e ealed ha nos algia-e oked men al simula ion p omo ed sel -awa eness and emo ional esonance, which
in u n inc eased mo i a ion o qui smoking. Responden s who emo ionally connec ed wi h he nos algic con en
epo ed g ea e awa eness o smoking- ela ed heal h isks and s onge in en ions o educe o cease smoking.
Howe e , he in e en ion’s e ec i eness a ied based on ac o s like emo ional sensi i i y and smoking his o y,
highligh ing he impo ance o pe sonalized app oaches. The indings unde sco e he psychological bene i s o
combining cogni i e simula ion wi h emo ionally esonan messaging and sugges ha such in eg a ion may enhance
he e ec i eness o cessa ion p og ams. This s udy con ibu es o he de elopmen o ailo ed, emo ionally g ounded
public heal h in e en ions and calls o u he explo a ion o long- e m and cul u ally speci ic ou comes.
Keywo ds: Nos algia-E oked Message; Men al Simula ion; Smoke s’ A i ude; Beha iou al
1. In oduc ion
Men al simula ion is an es ablished cogni i e mechanism ha enables indi iduals o isualize and men ally ehea se
u u e scena ios, os e ing mo i a ion, sel -e icacy, and beha iou al commi men . As a beha iou change echnique,
men al simula ion acili a es goal-di ec ed hinking by allowing indi iduals o an icipa e he consequences o hei
ac ions and de elop s a egies o achie e a desi ed ou come [3]. Wi hin he ealm o heal h in e en ions, his app oach
has demons a ed e icacy in p omo ing physical ac i i y, die a y imp o emen s, and addic ion eco e y, including
smoking cessa ion [8]. When combined wi h nos algia-e oked messaging, men al simula ion may se e as an e en mo e
compelling pe suasi e ool. Nos algia—a sen imen al e lec ion on pe sonally signi ican pas expe iences—has been
shown o ein o ce sel -con inui y, enhance mo i a ion, and s eng hen goal-di ec ed beha iou s [12]. In he con ex o
smoking cessa ion, nos algia-d i en in e en ions may elici emo ional connec ions o heal hie pas expe iences,
pe sonal iden i y, and signi ican li e e en s, he eby inc easing he pe sonal ele ance o cessa ion e o s. Despi e i s
po en ial, he in eg a ion o men al simula ion and nos algia-based messaging in smoking cessa ion in e en ions
emains unde explo ed. Tobacco use emains a pe sis en global public heal h challenge, con ibu ing signi ican ly o
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 825-832
826
p e en able diseases such as lung cance and co ona y hea disease. The Wo ld Heal h O ganiza ion [15] epo s ha
obacco- ela ed illnesses accoun o o e 8 million dea hs annually, including app oxima ely 1.2 million a ali ies due
o second-hand smoke exposu e. Despi e nume ous public heal h ini ia i es aimed a cu bing obacco consump ion,
smoking p e alence emains high, pa icula ly in Malaysia, whe e obacco use has been deeply embedded in cul u al
and social no ms. Agg essi e ma ke ing s a egies by he obacco indus y ha e con ibu ed o he no maliza ion o
smoking, in luencing indi iduals ac oss a ious age g oups and pe pe ua ing smoking as a socially accep ed li es yle
choice. The Na ional Heal h Mo bidi y Su ey [11] unde sco es he se e i y o smoking p e alence in Malaysia,
epo ing ha smoking is esponsible o 27,200 dea hs annually, wi h app oxima ely 4.8 million indi iduals aged 15
and abo e ac i ely smoking. Men a e disp opo iona ely a ec ed, being o e 30 imes mo e likely han women o be
cu en smoke s. In esponse o his ala ming end, Malaysia in oduced he Na ional S a egic Plan on Tobacco Con ol
(NSPTC) 2015-2020, a ge ing a educ ion in smoking p e alence o 15% by 2025 and ul ima ely en isioning a obacco-
ee gene a ion by 2045 in alignmen wi h he WHO’s Noncommunicable Diseases Global Ta ge . Recognizing he
u gency o he si ua ion, he Wo ld Hea Fede a ion (WHF) has endo sed Malaysia’s Gene a ional End Game (GEG)
policy, which aims o p e en nico ine addic ion among u u e gene a ions by p ohibi ing he sale o obacco p oduc s
o indi iduals bo n a e a speci ied yea . This ini ia i e, suppo ed by he Sou heas Asia Tobacco Con ol Alliance
(SEATCA), is expec ed o yield long- e m bene i s in public heal h, social well-being, and economic s abili y [13].
Howe e , while policy-d i en app oaches play a c ucial ole, e ec i e smoking cessa ion in e en ions mus also
add ess indi idual-le el mo i a ion and beha iou al change mechanisms. Con en ional smoking cessa ion campaigns
ha e p ima ily elied on emo ional appeals—such as ea , guil , disgus , and ange — o encou age beha iou
modi ica ion [16]. Fea -based messaging has been ex ensi ely u ilized in public heal h ini ia i es a ge ing high- isk
beha iou s, including smoking, unsa e sexual p ac ices, binge d inking, and subs ance abuse [2 ,14, 16] Howe e ,
e idence sugges s ha such app oaches o en ail o induce sus ained beha iou change, pa icula ly among indi iduals
who a e al eady awa e o he associa ed heal h isks [9]. Mo eo e , ea appeals may elici psychological eac ance,
leading o de ensi e esponses ha educe message e ec i eness [9]. Gi en hese limi a ions, al e na i e
communica ion s a egies a e needed o enhance pe sonal engagemen , cogni i e e lec ion, and mo i a ion o
beha iou change. Nos algia-based messaging, when in eg a ed wi h men al simula ion echniques, o e s a no el
app oach o enhancing cogni i e and emo ional p ocessing in smoking cessa ion in e en ions. Ra he han e oking
nega i e emo ions, nos algia econnec s indi iduals wi h meaning ul pas expe iences, ein o cing a sense o iden i y,
sel -e icacy, and pe sonal agency in qui ing smoking.
Men al image y plays a cen al ole in his p ocess, enabling indi iduals o men ally ehea se posi i e smoking cessa ion
scena ios, he eby inc easing mo i a ion, con idence, and eadiness o beha iou al change. Guided image y
in e en ions ha e shown p omise in enhancing smoking cessa ion ou comes, as hey allow indi iduals o isualize
hemsel es as non-smoke s, expe iencing imp o ed heal h, emo ional well-being, and eedom om addic ion [4].
Men al simula ion, as a cogni i e ool, can be ca ego ized in o wo p ima y p ocesses:
Ou come Simula ion – Indi iduals imagine he posi i e esul s o qui ing smoking, such as be e espi a o y heal h,
inc eased physical endu ance, and inancial sa ings. This p ocess s eng hens goal commi men by ein o cing
an icipa ed bene i s [8].
P ocess Simula ion – Indi iduals men ally ehea se he s eps equi ed o o e come smoking igge s, de elop coping
s a egies, and main ain hei commi men o cessa ion. P ocess simula ion os e s p oblem-sol ing skills and
p epa edness, essen ial o sus ained beha iou change [3].
By in eg a ing men al simula ion wi h nos algia-e oked messaging, smoking cessa ion in e en ions can inc ease
emo ional engagemen , ein o ce sel -iden i y, and enhance mo i a ion o long- e m beha iou change. Howe e ,
esea ch in his a ea emains limi ed, pa icula ly in unde s anding indi idual di e ences in esponse o nos algia-
based in e en ions. Fac o s such as pe sonal smoking his o y, emo ional sensi i i y, and pas expe iences may
in luence how indi iduals in e p e and engage wi h nos algic messaging in he con ex o smoking cessa ion. This s udy
seeks o b idge his gap by explo ing he ole o nos algia-d i en men al simula ion in in luencing smoke s’ a i udes
and beha iou al in en ions. By examining esponden s’ sel - e lec ions and cogni i e-emo ional esponses o nos algia-
based in e en ions, his esea ch aims o p o ide e idence-based insigh s o de eloping ailo ed smoking cessa ion
p og ams ha enhance pe sonal engagemen , mo i a ion, and sus ained beha iou change.
2. Ma e ials and me hod
A quali a i e esea ch design was employed o examine he e ec s o men al simula ion and nos algia-e oked
messaging on smoking cessa ion a i udes. This s udy cons i u ed he second phase o a b oade expe imen al
in es iga ion. The in e en ion u ilized a men al simula ion echnique o manipula e message exposu e, wi h
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 825-832
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esponden s assigned o one o ou condi ions: h ee ea men g oups exposed o nos algia-based messaging (pas
image y, physiological eac ance, and posi i e emo ions) and a con ol g oup ecei ing con en ional heal h messages.
Responden s’ cogni i e and emo ional esponses o he in e en ion we e subsequen ly assessed. The s udy was
conduc ed du ing he ope a ional hou s o he Qui Smoking Clinic P og am a h ee go e nmen hospi als in Peninsula
Malaysia. Each esponden was alloca ed 30 minu es in a con olled en i onmen o comple e he in e en ion. P io o
he simula ion, a baseline assessmen was conduc ed, measu ing esponden s’ beha iou al a i udes owa d smoking
cessa ion. Pa icipan s we e andomly assigned o one o ou expe imen al g oups: Pas Image y G oup – Exposed o
messages e oking nos algic memo ies o a smoke- ee pas , Physiological Reac ance G oup – Recei ed messages
emphasizing he s uggle o nico ine dependence and he challenges o qui ing, Posi i e Emo ions G oup – P esen ed
wi h messages emphasizing hope, enewal, and he bene i s o a smoke- ee u u e. Las ly, Con ol G oup – Recei ed
s anda d heal h- ocused messages de oid o nos algia- ela ed con en . Be o e pa icipa ing, esponden s e iewed he
inclusion and exclusion c i e ia ou lined in he consen o m. E hical conside a ions we e upheld by ensu ing ha all
pa icipan s me he s ipula ed c i e ia and p o ided in o med consen . To ensu e andomized alloca ion, each
esponden selec ed a andom numbe (1-4), which de e mined hei assignmen o one o he ou g oups. Du ing he
in e en ion, pa icipan s lis ened o a 10-minu e p e- eco ded audio message aligned wi h hei assigned condi ion.
The audio messages we e designed o elici cogni i e and emo ional engagemen , pa icula ly h ough men al
simula ion and nos algia-d i en con en . Following he in e en ion, a pos -assessmen was conduc ed a e a 10–15-
minu e in e al o e alua e pa icipan s’ sel - e lec ions and esponses o he messages.
The s imuli o he in e en ion consis ed o ou dis inc p e- eco ded message sc ip s, each co esponding o one o
he expe imen al condi ions:
• Pas Image y Messages: Adap ed om Hussain and Lapinski’s [5] esea ch on public se ice announcemen s
(PSAs), hese messages inco po a ed nos algic image y o e oke memo ies o li e be o e smoking ini ia ion.
• Physiological Reac ance Messages: De eloped based on smoking cessa ion guidelines om he Minis y o
Heal h Malaysia and he Wo ld Heal h O ganiza ion (WHO), hese messages emphasized he challenges o
nico ine wi hd awal and he s uggle o o e coming addic ion.
• Posi i e Emo ion Messages: Designed o p omo e empowe men , sel -e icacy, and op imism, emphasizing he
pe sonal and social bene i s o qui ing smoking.
• Con ol G oup Messages: De i ed om s anda d In o ma ion, Educa ion, and Communica ion (IEC) ma e ials,
hese messages con ained ac ual, heal h-based smoking cessa ion in o ma ion wi hou nos algia o simula ion
elemen s.
The selec ion o message con en was based on exis ing e idence-based amewo ks o smoking cessa ion
in e en ions. While he pas image y sc ip was adap ed om alida ed Public Se ice Announcemen (PSA) esea ch,
he o he sc ip s we e de eloped based on widely ecognized smoking cessa ion ma e ials. Al hough hese ma e ials
ha e no been ex ensi ely es ed using men al simula ion echniques, p e ious s udies sugges ha posi i e message
aming can e ec i ely e oke emo ions and in luence beha iou change. The s udy a ge ed adul smoke s en olled in
he Qui Smoking Clinic P og am a h ee majo go e nmen hospi als in Peninsula Malaysia, namely Hospi al
Pu ajaya, Hospi al Tuanku Ampuan Rahimah, and Hospi al Tuanku Jaa a . Pa icipan s we e equi ed o be 18 yea s o
olde , aligning wi h he p edominan demog aphic o smoke s, as indica ed by he Na ional Heal h Mo bidi y Su ey
2015. This s udy aimed o examine a ia ions in nos algia suscep ibili y, cogni i e engagemen , and mo i a ional shi s,
con ibu ing o a deepe unde s anding o how men al simula ion and nos algia-d i en messaging in luence smoking
cessa ion a i udes.
2.1. Da a analysis
A na a i e analysis app oach was employed o examine and in e p e he quali a i e da a collec ed om esponden s
ollowing hei pa icipa ion in men al simula ion exe cises in ol ing nos algia-e oked messaging. The p ima y
objec i e o his analysis was o gain deepe insigh in o esponden s' pe sonal accoun s, e lec ions, and emo ional
expe iences ela ed o hei smoking beha iou s and hei eac ions o he in e en ion messages. By u ilizing na a i e
analysis, he s udy mo ed beyond su ace-le el esponses o explo e how indi iduals cons uc ed meaning a ound hei
smoking habi s, heal h- ela ed a i udes, and he ole o nos algic memo ies in shaping cogni i e and emo ional
p ocesses associa ed wi h smoking cessa ion.
The na a i e analysis in his s udy ollowed a s uc u ed app oach, consis ing o se e al key s ages [10]:
• Da a Familia iza ion – The esea che conduc ed an in-dep h e iew o esponden s' w i en e lec ions,
ca e ully eading and e- eading he con en o de elop a comp ehensi e unde s anding. This phase acili a ed
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 825-832
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he iden i ica ion o ecu ing pa e ns, emo ional esponses, and signi ican li e e en s linked o smoking
beha iou s and nos algia-e oked men al simula ions.
• Iden i ica ion o Na a i es – Ra he han ex ac ing isola ed hemes o keywo ds, he analysis ocused on
ecognizing comple e pe sonal accoun s sha ed by esponden s. These na a i es equen ly cen ed on amily
memo ies, heal h- ela ed expe iences, pe sonal s uggles wi h smoking, and ans o ma i e ealiza ions
igge ed by nos algic messages.
• In e p e a ion o Meaning – The na a i es we e u he examined o unco e unde lying emo ions,
mo i a ions, and cogni i e shi s exp essed by esponden s. Pa icula a en ion was gi en o how indi iduals
amed hei pas smoking expe iences, posi ioned hemsel es wi hin hei s o ies (e.g., as agen s o change o
indi iduals s uggling wi h addic ion), and how hei e lec ions in luenced hei cu en a i udes owa d
smoking cessa ion.
• In eg a ion wi h Beha iou al Insigh s – The quali a i e indings we e analysed alongside beha iou al
indica o s o assess how men al simula ion and nos algia-e oked messaging in luenced esponden s' hough
p ocesses. E en in cases whe e physiological measu es such as na a i e e lec ions o en e ealed signi ican
cogni i e and emo ional s uggles, indica ing a g adual shi in smoking- ela ed pe cep ions and in en ions.
• Cons uc ion o he O e all Na a i e – Finally, he indi idual na a i es we e syn hesized o de elop a b oade
unde s anding o how nos algia-d i en men al simula ion in luenced smoking cessa ion a i udes and
beha iou s. This p ocess unde sco ed he emo ional and e lec i e dimensions o qui ing smoking,
highligh ing how nos algia-e oked messaging acili a ed cogni i e engagemen , sel - e lec ion, and mo i a ion
o beha iou al change. The indings complemen ed he quan i a i e da a, o e ing a mo e nuanced pe spec i e
on he ole o nos algia and men al simula ion in p omo ing smoking cessa ion.
3. Resul s and discussion
The quali a i e analysis examined he ole o men al simula ion and nos algia-e oked messaging in in luencing
esponden s' cogni i e and emo ional engagemen wi h smoking cessa ion. By employing na a i e analysis, his s udy
p o ided a holis ic unde s anding o how indi iduals p ocessed, in e nalized, and esponded o nos algic s imuli in
ela ion o hei smoking beha iou s. Unlike adi ional hema ic coding app oaches, which emphasize isola ed hemes,
na a i e analysis allowed o an in-dep h explo a ion o he cohe ence, s uc u e, and emo ional dep h o pa icipan s’
e lec ions, e ealing key psychological mechanisms unde lying beha iou al change.
The analysis e ealed ha nos algia-e oked men al simula ion enhanced mo i a ion o smoking cessa ion, pa icula ly
by os e ing sel - e lec ion and emo ional engagemen . Mos esponden s exp essed a heigh ened awa eness o hei
smoking habi s and demons a ed an inc eased willingness o educe o qui smoking. The indings indica e ha men al
simula ion, when in eg a ed wi h nos algia-d i en messaging, can se e as a ca alys o sel -examina ion, ein o cing
pe sonal heal h goals and s eng hening he in en ion o qui . Fu he mo e, many esponden s linked hei mo i a ion
o qui smoking wi h emo ionally signi ican memo ies, including expe iences ela ed o amily, pas heal h condi ions,
and meaning ul li e e en s. These indings align wi h exis ing esea ch on men al simula ion, which sugges s ha high-
quali y men al simula ions enhance sel -e icacy, goal-se ing, and beha iou al pe se e ance [3, 7,]. Responden s who
engaged mo e deeply wi h nos algia-based scena ios we e mo e likely o a icula e a clea commi men o beha iou
change, ein o cing he no ion ha nos algia se es as a psychological mechanism ha acili a es g adual shi s in
cogni ion and beha iou .
3.1. Emo ional and Social In luences
The ole o social ac o s in beha iou modi ica ion also eme ged as a signi ican heme. Se e al esponden s no ed ha
amily and pee in luences played a c i ical ole in ein o cing hei a i udes owa d smoking cessa ion. These indings
sugges ha nos algia-e oked messages may be pa icula ly e ec i e when hey emphasize social connec ions and
sha ed pas expe iences, as such con en may esona e mo e deeply wi h indi iduals seeking emo ional and social
suppo du ing hei qui ing p ocess. Howe e , he s udy also iden i ied indi idual di e ences in esponse o nos algia-
e oked messaging. While mos pa icipan s eac ed posi i ely, one esponden indica ed ha he messages lacked
pe sonal ele ance, highligh ing he impo ance o message aming and indi idual suscep ibili y o nos algia. This
sugges s ha ailo ing nos algia-based in e en ions o align wi h an indi idual’s pe sonal expe iences may enhance
e ec i eness.
3.2. Suppo ing Responden s’ Pe spec i es
The ollowing pa icipan e lec ions illus a e how men al simula ion and nos algia-d i en messaging in luenced
smoking cessa ion a i udes:
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"Make me hink abou my heal h, I am ac i e bu usually sho o b ea h. I need s amina. I ’s ha d, bu I need o cu down
my ciga e es and hang ou wi h iends who smoke." (ID30)
"Helped me o qui smoking by educing my ciga e e in ake, bu I need u he guidance om his clinic." (ID1)
Con e sely, one pa icipan exp essed a limi ed connec ion o he message con en , emphasizing he need o
pe sonalized app oaches:
"I eel ha he message was no pa icula ly help ul o me; howe e , I am s ill able o g adually educe my smoking by
a oiding excessi e s ess and d awing inspi a ion om how my pa en s success ully qui smoking." (ID22)
3.3. Implica ions o Beha iou Change In e en ions
Men al simula ion enables indi iduals o men ally ehea se u u e scena ios, ein o cing sel -e icacy and commi men
o smoking cessa ion. When combined wi h nos algia, which e okes meaning ul pas expe iences, his app oach
s eng hens pe sonal mo i a ion by econnec ing indi iduals wi h p e ious iden i ies, alues, and social in luences ha
may ha e discou aged smoking. These indings align wi h esea ch sugges ing ha high-quali y men al simula ions
enhance goal-di ec ed beha iou s, pe se e ance, and cogni i e es uc u ing [3, 7,]. To enhance he e ec i eness o
smoking cessa ion in e en ions, ailo ed nos algia-e oked men al simula ion exe cises should be in eg a ed in o
exis ing beha iou change amewo ks by inco po a ing pe sonalized s o y elling in e en ions ha guide indi iduals
o isualize hei smoke- ee u u e while d awing on nos algic e lec ions o pas heal h, social connec ions, o pe sonal
achie emen s, as well as u ilizing mul imedia-based in e en ions, such as audio-guided men al simula ion exe cises o
ideo-based nos algic na a i es, o c ea e imme si e and emo ionally engaging expe iences.
Addi ionally, indi idual di e ences in nos algia suscep ibili y and emo ional esponsi eness should be conside ed in
in e en ion design. While some indi iduals may espond s ongly o nos algia-d i en messaging, o he s may equi e
mo e s uc u ed cogni i e sca olding o ansla e nos algic e lec ions in o meaning ul ac ion. Fu u e esea ch should
explo e how ac o s such as age, cul u al backg ound, and emo ional p ocessing s yles in luence he e ec i eness o
nos algia-based in e en ions, ensu ing ha such s a egies a e inclusi e and adap able o di e se popula ions. By
in eg a ing men al simula ion and nos algia-e oked messaging in o smoking cessa ion p og ams, public heal h
p ac i ione s can de elop mo e engaging, psychologically g ounded in e en ions ha os e long- e m mo i a ion and
beha iou al commi men . These indings con ibu e o he g owing e idence suppo ing emo ionally esonan ,
cogni i ely imme si e heal h communica ion s a egies as an al e na i e o adi ional pe suasi e messaging in
beha iou change in e en ions.
3.4. Men al Simula ion as a Mechanism o A i ude and Beha iou Change
The indings align wi h exis ing esea ch ha sugges s men al simula ion unc ions as a po en cogni i e ool o
in luencing heal h beha iou s [3]. By allowing indi iduals o men ally ehea se a smoke- ee u u e, men al simula ion
os e s sel -e icacy, mo i a ion, and goal-di ec ed ac ion. In his s udy, esponden s who engaged in nos algia-e oked
men al image y demons a ed g ea e emo ional in ol emen and sel - e lec ion, bo h o which a e c i ical in shaping
beha iou al in en ions. The na a i es sugges ha many esponden s en isioned hemsel es as non-smoke s,
ein o cing he cogni i e es uc u ing necessa y o pe cei ing cessa ion as an achie able goal. Addi ionally, he
indings con i m ha nos algia se es as an emo ional b idge be ween pas expe iences and p esen beha iou s,
ein o cing he belie ha qui ing smoking can es o e a sense o well-being and align wi h a mo e posi i e sel -concep .
This aligns wi h p io esea ch sugges ing ha nos algia s eng hens sel -con inui y and enhances mo i a ion o goal-
di ec ed beha iou [12]. Th ough he ecollec ion o meaning ul pas expe iences, esponden s we e able o e ame
hei cu en smoking habi s in ela ion o hei pe sonal iden i y, heal h aspi a ions, and social in luences.
3.5. Cogni i e and Emo ional Responses o Men al Simula ion and Nos algia
A key con ibu ion o his s udy is he ich quali a i e na a i es ha illus a e he emo ional and cogni i e dimensions
o nos algia-e oked men al simula ion. The analysis iden i ied h ee p ima y mechanisms h ough which men al
simula ion in luenced smoking cessa ion a i udes: sel - e lec ion and pe sonal ealiza ion, emo ional esonance and
mo i a ional shi s, and a iabili y in indi idual esponses.
3.6. Sel -Re lec ion and Pe sonal Realiza ion
Nos algia-e oked messages o en p omp ed in ospec ion among esponden s, leading o g ea e awa eness o he long-
e m heal h isks o smoking and an inc eased sense o pe sonal esponsibili y o qui ing. Many pa icipan s e lec ed
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on hei physical well-being and li es yle choices, ecognizing he nega i e impac o smoking on hei heal h. One
esponden exp essed:
“This made me hink abou my heal h. I am ac i e bu usually sho o b ea h. I need s amina. I ’s ha d, bu I need o cu
down my ciga e es and hang ou wi h iends who don’ smoke.” (ID30)
This esponse highligh s how men al simula ion acili a es cogni i e es uc u ing, allowing indi iduals o e ame hei
smoking beha iou s in he con ex o hei long- e m heal h goals and o e all well-being. By isualizing a heal hie ,
smoke- ee u u e, esponden s we e able o shi hei pe cep ion o cessa ion om a challenge o an a ainable goal.
3.7. Emo ional Resonance and Mo i a ional Shi s
The s udy indings indica e ha nos algia-e oked men al simula ion is deeply in e wined wi h emo ional engagemen ,
which plays a c i ical ole in os e ing mo i a ion o beha iou change. Responden s who ecalled emo ionally
signi ican pas expe iences equen ly associa ed hem wi h eelings o loss, eg e , o longing, ein o cing hei desi e
o qui smoking. One pa icipan sha ed how pe sonal loss in luenced hei mo i a ion:
“Hea ing he message made me emembe my a he , who was a smoke and passed away om lung disease. I don’ wan
my kids o go h ough he same hing.” (ID12)
This inding is consis en wi h p e ious esea ch sugges ing ha emo ionally cha ged memo ies se e as mo i a ional
ca alys s, encou aging indi iduals o eassess hei smoking beha iou s conside ing hei pas expe iences and u u e
aspi a ions [1]. Nos algia’s abili y o e oke s ong emo ional connec ions enhances he pe sonal ele ance o smoking
cessa ion, ein o cing i as a meaning ul and necessa y change.
3.8. Va iabili y in Indi idual Responses
While mos esponden s esponded posi i ely o nos algia-e oked men al simula ion, a subse o pa icipan s epo ed
di icul y in emo ionally connec ing wi h he messages. Some s uggled o isualize hemsel es as non-smoke s,
sugges ing ha indi idual di e ences in nos algia suscep ibili y, emo ional sensi i i y, and smoking his o y may
in luence how e ec i ely he in e en ion esona es. One pa icipan exp essed:
“I unde s and he message, bu I don’ hink i applies o me. I’ e been smoking o oo long.” (ID5)
This esponse sugges s ha nos algia-based in e en ions may no be uni e sally e ec i e, and message aming should
be ailo ed o accommoda e indi idual di e ences in smoking his o y and emo ional ecep i i y. Fu u e esea ch should
explo e pe sonalized app oaches ha enhance engagemen o indi iduals who may equi e s onge cogni i e
sca olding o isualize a smoke- ee u u e.
4. Conclusion
This s udy p o ides compelling e idence ha men al simula ion, pa icula ly when pai ed wi h nos algia-e oked
message, se es as a powe ul cogni i e and emo ional mechanism o p omo ing smoking cessa ion. By enabling
indi iduals o men ally ehea se a smoke- ee u u e while d awing upon emo ionally signi ican pas expe iences, his
app oach os e s sel - e lec ion, emo ional engagemen , and inc eased mo i a ion o qui smoking. The quali a i e
indings sugges ha nos algia-d i en men al simula ion enhances cogni i e es uc u ing, ein o cing he belie ha
qui ing smoking is bo h achie able and aligned wi h pe sonal iden i y and long- e m well-being. The indings u he
demons a e ha emo ional esonance plays a c i ical ole in beha iou change, as esponden s who connec ed wi h
nos algic messages o en exp essed a heigh ened awa eness o smoking- ela ed heal h isks and a s onge in en ion o
qui . Howe e , he s udy also highligh s a iabili y in indi idual esponses, wi h some pa icipan s s uggling o
emo ionally connec wi h he messages, sugges ing ha pe sonalized app oaches may be necessa y o maximize he
e ec i eness o nos algia-based in e en ions. As smoking cessa ion is a g adual, mul i-s age p ocess, in eg a ing
men al simula ion wi h nos algia-e oked messaging in o smoking cessa ion p og ams may p o ide a mo e engaging,
psychologically g ounded al e na i e o con en ional ea -based o a ional heal h communica ion s a egies. Fu u e
esea ch should u he explo e how indi idual di e ences in nos algia ecep i i y, smoking his o y, and emo ional
p ocessing in luence he e ec i eness o hese in e en ions. Addi ionally, in es iga ing longi udinal e ec s and eal-
wo ld applica ions, such as digi al heal h in e en ions o communi y-based p og ams, could p o ide aluable insigh s
in o he sus ained impac o nos algia-d i en men al simula ion on smoking cessa ion ou comes. By e ining
pe sonalized, e idence-based smoking cessa ion s a egies, public heal h p ac i ione s can le e age he cogni i e and
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 825-832
831
emo ional powe o nos algia and men al simula ion o enhance he e ec i eness o smoking cessa ion in e en ions,
ul ima ely suppo ing indi iduals in making las ing beha iou al changes.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho s wish o hank Uni e si i Pu a Malaysia o hei emendous suppo . Special hanks a e also ex ended o
he pa icipa ing hospi als, and esponden s o hei in ol emen in he s udy.
Disclosu e o con lic o in e es
We decla e no con lic o in e es .
S a emen o e hical app o al
E hical app o al o his s udy was sough om he Medical Re iew & E hics Commi ee (MREC) and also Uni e si i
Pu a Malaysia E hics Comi ee . P io o he pa icipa ion, all esponden s we e p o ided wi h a comp ehensi e
explana ion o he s udy’s objec i es, including any po en ial isks and bene i s.
S a emen o in o med consen
In o med consen was ob ained om pa icipan s h ough a designa ed consen ques ion embedded in he su ey.
Pa icipa ion was en i ely olun a y, and indi iduals has e ain he igh o wi hd aw om he s udy a any poin
wi hou penal y. An in o ma ion shee and o mal consen o m was p o ided o each po en ial pa icipan du ing he
ec ui men p ocess. Addi ionally, e bal consen was ob ained when pa icipan s a e con ac ed ia elephone o ensu e
hei unde s anding and willingness o pa icipa e.
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