Digital Program and mHealth App Could Increase Smoking Cessation

Samara Rosenfeld
JULY 09, 2019
cigarette

Using a web-delivered growth mindset intervention and a smartphone app could improve smoking cessation, according to the findings of a study published in JMIR mHealth and uHealth.
 
While engagement was the primary outcome measured by researchers, the secondary outcome, cessation, increased among participants who used the digital interventions. Researchers saw a 64% increase in the odds of quitting in the experimental group compared to the control group.
 
“When scaled to a population level and considering the cost-effectiveness of technological interventions and health benefits accrued from each additional person who quits or reduces smoking, even a 1% improvement in quit rates can be clinically significant,” the study authors wrote.
 
Participants who used a web-based intervention — which included eight lessons to reframe cessation and addiction — and a smartphone app, SmartQuit, logged into the app approximately two fewer times.


Selecting Participants

Researchers set out to discover the feasibility, utility and efficacy of a web-based growth mindset intervention for addiction when used with a smoking cessation app. The researchers measured engagement by the number of logins to the smoking cessation app. They measured cessation through a two-month online follow-up survey.
 
The research team recruited 398 daily smokers. They were at least 18 years old, smoking at least five cigarettes per day for the past year and ready to quit in the next 30 days.
 
Researchers randomly assigned each participant to receive either a cessation app or the app plus a web-delivered growth mindset intervention.


Creating the Mindset Intervention

The mindset intervention was designed to influence participants’ beliefs about the permanence of addiction. The six beliefs used to create the intervention content included:
  1. Addiction is permanent because it is genetic.
  2. Some people will always be addicted because they have an addictive personality.
  3. Addiction is permanent because it irreversibly changes the brain.
  4. Addiction is permanent because withdrawal symptoms may persist after cessation.
  5. Addiction is permanent because people might want to smoke even years after quitting.
  6. Failure to quit smoking is indicative of a permanent habit.
Researchers created six information packets called Mindset Intervention for Nicotine Dependence (MIND) tips to counteract those beliefs. Investigators also created two additional lessons to provide an introduction and conclusion to the program.
 
Participants received an email on the day of their enrollment with their first MIND tip. Researchers sent the lessons one at a time, every three days.


Measuring mHealth App Use

Every participant had access to the SmartQuit application, which aims to facilitate smoking cessation. The app helped the participants create a quit plan, set a quit date and establish why they wanted to quit. SmartQuit automatically recorded usage of the app for two months from the date each participant enrolled. The number of logins indicated use.
 
Researchers also examined the number of days each participant used the app and whether they received the certificate of completion, which predicted four times higher odds of cessation in a previous trial.
 
After two months, participants completed the Fagerström Test for Nicotine Dependence and reported the last time they smoked, how many cigarettes they smoked over the past 30 days and how many times they attempted to quit. Researchers defined cessation as self-reported 30-day point prevalence abstinence at the two-month follow-up.
 
Slightly more than 78% of the participants in the intervention group viewed at least one page of MIND tips, and 21.1% viewed all eight. Participants viewed an average of 4.16 tips. In both groups, 72% of participants logged into SmartQuit at least once. Participants in the control group logged in 21.61 times, while the experimental group logged in 19.46 times.
 
Completion of the web-based program had similar results, with 31% of the experimental group receiving a certificate, compared to 30% in the control group.
 
Future iterations of the study should explore how to improve the adoption and efficacy of the mindset intervention, the study authors wrote.

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