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Lee H, Choi EH, Shin JU, Kim TG, Oh J, Shin B, Sim JY, Shin J, Kim M. The Impact of Intervention Design on User Engagement in Digital Therapeutics Research: Factorial Experiment With a Mixed Methods Study. JMIR Form Res 2024; 8:e51225. [PMID: 38335015 PMCID: PMC10891489 DOI: 10.2196/51225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/08/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND User engagement is crucial for digital therapeutics (DTx) effectiveness; due to variations in the conceptualization of engagement and intervention design, assessment and retention of engagement remain challenging. OBJECTIVE We investigated the influence of the perceived acceptability of experimental intervention components and satisfaction with core intervention components in DTx on user engagement, while also identifying potential barriers and facilitators to user engagement. METHODS We conducted a mixed methods study with a 2 × 2 factorial design, involving 12 outpatients with atopic dermatitis. Participants were randomized into 4 experimental groups based on push notification ("basic" or "advanced") and human coach ("on" or "off") experimental intervention components. All participants engaged in self-monitoring and learning courses as core intervention components within an app-based intervention over 8 weeks. Data were collected through in-app behavioral data, physician- and self-reported questionnaires, and semistructured interviews assessed at baseline, 4 weeks, and 8 weeks. Descriptive statistics and thematic analysis were used to evaluate user engagement, perceived acceptability of experimental intervention components (ie, push notification and human coach), satisfaction with core intervention components (ie, self-monitoring and learning courses), and intervention effectiveness through clinical outcomes. RESULTS The primary outcome indicated that group 4, provided with "advanced-level push notifications" and a "human coach," showed higher completion rates for self-monitoring forms and learning courses compared to the predetermined threshold of clinical significance. Qualitative data analysis revealed three key themes: (1) perceived acceptability of the experimental intervention components, (2) satisfaction with the core intervention components, and (3) suggestions for improvement in the overall intervention program. Regarding clinical outcomes, the Perceived Stress Scale and Dermatology Life Quality Index scores presented the highest improvement in group 4. CONCLUSIONS These findings will help refine the intervention and inform the design of a subsequent randomized trial to test its effectiveness. Furthermore, this design may serve as a model for broadly examining and optimizing overall engagement in DTx and for future investigation into the complex relationship between engagement and clinical outcomes. TRIAL REGISTRATION Clinical Research Information Service KCT0007675; http://tinyurl.com/2m8rjrmv.
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Affiliation(s)
- Hyerim Lee
- Department of Psychology, College of Liberal Arts, Yonsei University, Seoul, Republic of Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Tae-Gyun Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bokyoung Shin
- Department of Integrative Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Yeon Sim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Meelim Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
- The Design Lab, University of California San Diego, San Diego, CA, United States
- Center for Wireless & Population Health Systems, Calit2's Qualcomm Institute, University of California San Diego, San Diego, CA, United States
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Vila-Farinas A, Pérez-Ríos M, Montes-Martínez A, Trinanes-Pego Y, Varela-Lema L. [Considerations for the design and implementation of interventions for the cessation of tobacco, alcohol and cannabis use in pregnancy: A qualitative study]. Aten Primaria 2023; 55:102732. [PMID: 37573833 PMCID: PMC10448272 DOI: 10.1016/j.aprim.2023.102732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. DESIGN A qualitative study with phenomenological approach. SITE: The study was conducted in Spain in 2022. PARTICIPANTS Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. METHODS Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. RESULTS Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. CONCLUSIONS The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.
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Affiliation(s)
- Andrea Vila-Farinas
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España
| | - Mónica Pérez-Ríos
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España.
| | - Agustín Montes-Martínez
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España
| | - Yolanda Trinanes-Pego
- Unidad de Asesoramiento Científico-técnico (Avalia-t). Agencia Gallega de Conocimiento en Salud (ACIS), Galicia , España
| | - Leonor Varela-Lema
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España
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Tahan C, Dobbins T, Hyslop F, Lingam R, Richmond R. Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis. BMJ Open 2023; 13:e060549. [PMID: 36963792 PMCID: PMC10040078 DOI: 10.1136/bmjopen-2021-060549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and postpartum. SETTINGS Any healthcare setting servicing pregnant women, including any country globally. PARTICIPANTS Pregnant women of any social, ethnic or geographical background who smoke. METHODS We searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence. RESULTS We identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision. CONCLUSION NoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.
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Affiliation(s)
- Chadi Tahan
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Fran Hyslop
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Paediatric Population Health, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Richmond
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
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Agràs-Guàrdia M, Martínez-Torres S, Granado-Font E, Pallejà-Millán M, Villalobos F, Patricio D, Ruiz F, Marin-Gomez FX, Duch J, Rey-Reñones C, Martín-Luján F. Effectiveness of an App for tobacco cessation in pregnant smokers (TOBBGEST): study protocol. BMC Pregnancy Childbirth 2022; 22:933. [PMID: 36514020 PMCID: PMC9745963 DOI: 10.1186/s12884-022-05250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tobacco consumption during pregnancy is one of the most modifiable causes of morbidity and mortality for both pregnant smokers and their foetus. Even though pregnant smokers are conscious about the negative effects of tobacco consumption, they also had barriers for smoking cessation and most of them continue smoking, being a major public health problem. The aim of this study is to determine the effectiveness of an application (App) for mobile devices, designed with a gamification strategy, in order to help pregnant smokers to quit smoking during pregnancy and in the long term. METHODS This study is a multicentre randomized community intervention trial. It will recruit pregnant smokers (200 participants/group), aged more than 18 years, with sporadically or daily smoking habit in the last 30 days and who follow-up their pregnancy in the Sexual and Reproductive Health Care Services of the Camp de Tarragona and Central Catalonia Primary Care Departments. All the participants will have the usual clinical practice intervention for smoking cessation, whereas the intervention group will also have access to the App. The outcome measure will be prolonged abstinence at 12 months after the intervention, as confirmed by expired-carbon monoxide and urinary cotinine tests. Results will be analysed based on intention to treat. Prolonged abstinence rates will be compared, and the determining factors will be evaluated using multivariate statistical analysis. DISCUSSION The results of this study will offer evidence about the effectiveness of an intervention using a mobile App in smoking cessation for pregnant smokers, to decrease comorbidity associated with long-term smoking. If this technology is proven effective, it could be readily incorporated into primary care intervention for all pregnant smokers. TRIAL REGISTRATION Clinicaltrials.gov ID NCT05222958 . Trial registered 3 February 2022.
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Affiliation(s)
- Maria Agràs-Guàrdia
- grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Primary Care Center Llibertat (Reus – 3, Institut Català de La Salut, Reus, Spain ,grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
| | - Sara Martínez-Torres
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.36083.3e0000 0001 2171 6620Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Ester Granado-Font
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Primary Care Center Horts de Miró (Reus – 4), Institut Català de La Salut, Reus, Spain
| | - Meritxell Pallejà-Millán
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain
| | - Felipe Villalobos
- grid.36083.3e0000 0001 2171 6620Universitat Oberta de Catalunya (UOC), Barcelona, Spain ,grid.452479.9Fundació Institut Universitari Per a La Recerca a L’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Demetria Patricio
- grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Atenció a La Salut Sexual I Reproductive (ASSIR), Institut Català de La Salut, Reus, Spain
| | - Francisca Ruiz
- grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain ,grid.22061.370000 0000 9127 6969Department of Primary Care Camp de Tarragona, Atenció a La Salut Sexual I Reproductive (ASSIR), Institut Català de La Salut, Reus, Spain
| | - Francesc X. Marin-Gomez
- grid.452479.9Primary Healthcare Research Support Unit Catalunya Central, Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain ,grid.22061.370000 0000 9127 6969Health Promotion in Rural Areas Research Group, Gerència Territorial de La Catalunya Central, Institut Català de La Salut, Sant Fruitós de Bages, Spain
| | - Jordi Duch
- grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.410367.70000 0001 2284 9230Department of Computer Engineering and Mathematics, Universitat Rovira I Virgili (URV), Tarragona, Spain
| | - Cristina Rey-Reñones
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.452479.9TICS-AP Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain
| | - Francisco Martín-Luján
- grid.452479.9Primary Healthcare Research Support Unit Camp de Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), C/Cami de Riudoms, 53-55. Reus-43202, Tarragona, Spain ,grid.410367.70000 0001 2284 9230School of Medicine and Health Sciences, Universitat Rovira I Virgili, Reus, Spain
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Khayat S, Palizvan M, Navidian A, Fanaei H, Sheikhi ZP. Comparison of the effect of face-to-face training and telemedicine on self-care in adolescent pregnant women: A quasi-experimental study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:326. [PMID: 36568013 PMCID: PMC9768710 DOI: 10.4103/jehp.jehp_1729_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Improving self-care in adolescent pregnancy leads to improved maternal and neonatal outcomes of pregnancy. However, self-care in adolescent pregnancy is less than other women. The aim of this study was to compare the effect of face-to-face training and telemedicine on self-care in adolescent pregnant women. MATERIALS AND METHODS The present study is a quasi-experimental study that was conducted in Zahedan in 2021 and 120 adolescent pregnant women with a gestational age of 15-20 weeks participated in it. The sampling was done in multistage, and the samples were divided into three groups: Face-to-face training, telemedicine, and control. Face-to-face training was presented in five sessions and the telemedicine group received the similar educational content through the mobile applications. The samples completed a researcher-made self-care questionnaire before the intervention and at 28 weeks of gestation. SPSS software version 21 was used for the analysis, and data were analyzed by ANOVA, Tukey post hoc, Kruskal-Wallis, and Mann-Whitney tests. RESULTS There was no significant difference in face-to-face and telemedicine training in improving the scores of nutritional performance, smoking and narcotics use, personal hygiene, and routine pregnancy care (P > 0.05), but face-to-face training caused more improvement in the scores of sports and physical activity as compared to telemedicine group (P = 0.04). Face-to-face training and telemedicine training in all domains led to a significant improvement in scores as compared to the control group (P < 0.05). CONCLUSION The results of this study showed that the face-to-face training and telemedicine methods were proper methods for self-care education in pregnant adolescent women. It is recommended to use these methods in promoting self-care in pregnant adolescent women.
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Affiliation(s)
- Samira Khayat
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Maryam Palizvan
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Navidian
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamed Fanaei
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Beard E, Brown J, Shahab L. Association of quarterly prevalence of e-cigarette use with ever regular smoking among young adults in England: a time-series analysis between 2007 and 2018. Addiction 2022; 117:2283-2293. [PMID: 35263816 PMCID: PMC9543274 DOI: 10.1111/add.15838] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/16/2022] [Indexed: 01/03/2023]
Abstract
AIMS To assess how changes in the prevalence of e-cigarette use among young adults have been associated with changes in the uptake of smoking in England between 2007 and 2018. DESIGN Time-series analysis of population trends with autoregressive integrated moving average with exogeneous input (ARIMAX models). SETTING England. PARTICIPANTS Data were aggregated quarterly on young adults aged 16-24 years (n = 37 105) taking part in the Smoking Toolkit Study. MEASURES In the primary analysis, prevalence of e-cigarette use was used to predict prevalence of ever regular smoking among those aged 16-24. Sensitivity analyses stratified the sample into those aged 16-17 and 18-24. Bayes' factors and robustness regions were calculated for non-significant findings [effect size beta coefficient (B) = 3.1]. FINDINGS There was evidence for no association between the prevalence of e-cigarette use and ever regular smoking among those aged 16-24 [B = -0.015, 95% confidence interval (CI) = -0.046 to 0.016; P = 0.341; Bayes factor (BF) = 0.002]. Evidence for no association was also found in the stratified analysis among those aged 16-17 (B = 0.070, 95% CI -0.014 to 0.155, P = 0.102; BF = 0.015) and 18-24 (B = -0.021, 95% CI -0.053 to 0.011; P = 0.205; BF = 0.003). These findings were able to rule out percentage point increases or decreases in ever regular smoking prevalence greater than 0.31% or less than -0.03% for 16-17-year-olds and 0.01 or -0.08% for 18-24-year-olds for every 1%-point increase in e-cigarette prevalence. CONCLUSION Prevalence of e-cigarette use among the youth population in England does not appear to be associated with substantial increases or decreases in the prevalence of smoking uptake. Small associations cannot be ruled out.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- SPECTRUM Consortium, Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- SPECTRUM Consortium, Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- SPECTRUM Consortium, Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Landoll RR, Vargas SE, Samardzic KB, Clark MF, Guastaferro K. The preparation phase in the multiphase optimization strategy (MOST): a systematic review and introduction of a reporting checklist. Transl Behav Med 2021; 12:291-303. [PMID: 34850214 DOI: 10.1093/tbm/ibab146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multicomponent behavioral interventions developed using the multiphase optimization strategy (MOST) framework offer important advantages over alternative intervention development models by focusing on outcomes within constraints relevant for effective dissemination. MOST consists of three phases: preparation, optimization, and evaluation. The preparation phase is critical to establishing the foundation for the optimization and evaluation phases; thus, detailed reporting is critical to enhancing rigor and reproducibility. A systematic review of published research using the MOST framework was conducted. A structured framework was used to describe and summarize the use of MOST terminology (i.e., preparation phase and optimization objective) and the presentation of preparation work, the conceptual model, and the optimization. Fifty-eight articles were reviewed and the majority focused on either describing the methodology or presenting results of an optimization trial (n = 38, 66%). Although almost all articles identified intervention components (96%), there was considerable variability in the degree to which authors fully described other elements of MOST. In particular, there was less consistency in use of MOST terminology. Reporting on the MOST preparation phase is varied, and there is a need for increased focus on explicit articulation of key design elements and rationale of the preparation phase. The proposed checklist for reporting MOST studies would significantly advance the use of this emerging methodology and improve implementation and dissemination of MOST. Accurate reporting is essential to reproducibility and rigor of scientific trials as it ensures future research fully understands not only the methodology, but the rationale for intervention and optimization decisions.
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Affiliation(s)
- Ryan R Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Sara E Vargas
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kristen B Samardzic
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Madison F Clark
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kate Guastaferro
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
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Kennedy M, Kumar R, Ryan NM, Bennett J, La Hera Fuentes G, Gould GS. Codeveloping a multibehavioural mobile phone app to enhance social and emotional well-being and reduce health risks among Aboriginal and Torres Strait Islander women during preconception and pregnancy: a three-phased mixed-methods study. BMJ Open 2021; 11:e052545. [PMID: 34819285 PMCID: PMC8614130 DOI: 10.1136/bmjopen-2021-052545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Describe the development and pretest of a prototype multibehavioural change app MAMA-EMPOWER. DESIGN Mixed-methods study reporting three phases: (1) contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, (2) value specification included user-workshop with an Aboriginal researcher, community members and experts, (3) codesign with Aboriginal researchers and community members, followed by a pretest of the app with Aboriginal women, and feedback from qualitative interviews and the user-Mobile Application Rating Scale (U-MARS) survey tool. SETTINGS Aboriginal women and communities in urban and regional New South Wales, Australia. PARTICIPANTS Phase 1: interviews, 8 Aboriginal women. Phase 2: workshop, 6 Aboriginal women. Phase 3: app trial, 16 Aboriginal women. U-MARS, 5 Aboriginal women. RESULTS Phase 1 interviews revealed three themes: current app use, desired app characteristics and implementation. Phase 2 workshop provided guidance for the user experience. Phase 3 app trial assessed all content areas. The highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however, functionality was problematic. CONCLUSIONS Developing a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behavioural change technique's coupled with the consultative approach has added rigour to this process. Using phone apps to implement behavioural interventions in Aboriginal community settings remains a new area for investigation. In the next iteration of the app, we aim to find better ways to personalise the content to women's needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.
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Affiliation(s)
- Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Ratika Kumar
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole M Ryan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jessica Bennett
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Gina La Hera Fuentes
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Gillian Sandra Gould
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
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Baker TB, Bolt DM, Smith SS. Barriers to Building More Effective Treatments: Negative Interactions Amongst Smoking Intervention Components. Clin Psychol Sci 2021; 9:995-1020. [PMID: 35003904 PMCID: PMC8740936 DOI: 10.1177/2167702621994551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Meaningfully improved mental and behavioral health treatment is an unrealized dream. Across three factorial experiments, inferential tests in prior studies showed a pattern of negative interactions suggesting that better clinical outcomes are obtained when participants receive fewer rather than more intervention components. Further, relatively few significant main effects were found in these experiments. Modeling suggested that negative interactions amongst components may account for these patterns. This paper evaluates factors that may contribute to such declining benefit: increased attentional or effort burden; components that produce their effects via the same capacity limited mechanisms, making their effects subadditive; and a tipping point phenomenon in which those near a hypothesized "tipping point" for change will benefit markedly from weak intervention while those far from the tipping point will benefit little from even strong intervention. New research should explore factors that cause negative interactions amongst components and constrain the development of more effective treatments.
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Affiliation(s)
- Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Daniel M. Bolt
- University of Wisconsin, Department of Educational Psychology, 1025 W. Johnson St., Madison, WI 53706
| | - Stevens S. Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
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10
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Rahman T, Foster J, Hera Fuentes GL, Cameron L, Gould GS. Perspectives about smoking cessation during pregnancy and beyond of Aboriginal women in Australia: A qualitative analysis using the COM-B model. Int J Gynaecol Obstet 2021; 155:282-289. [PMID: 34355395 DOI: 10.1002/ijgo.13854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aboriginal and Torres Strait Islander women (hereafter Aboriginal) and their babies experience poor health outcomes for which smoking is a major risk factor. This paper explores Aboriginal women's perspectives on and experiences of smoking cessation, within and outside pregnancy, and their use of smoking cessation services using the COM-B (Capability, Opportunity, Motivation as determinants of Behaviour) model to understand Aboriginal women's capabilities, opportunities, and motivation for smoking cessation. METHODS Data came from 11 focus groups conducted in regional New South Wales, Australia, with 80 women aged between 16 and 68 years. Thematic analysis was performed following the COM-B model. RESULTS Seven themes related to capability, opportunity, motivation, and smoking cessation behaviors were identified. The themes highlighted that agency, knowledge, and self-efficacy (as capability), a supportive social environment, and access to culturally appropriate services and resources (as opportunities), together with automatic and reflective motivations for quitting, may enable short- or long-term smoking cessation. CONCLUSION Smoking cessation interventions may be more effective if the dynamics of the COM-B factors are considered. Policy and practice changes for further enhancing regional Aboriginal women's psychological capability and supportive social environments, and making smoking cessation services culturally appropriate are warranted.
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Affiliation(s)
- Tabassum Rahman
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Joley Foster
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Gina L Hera Fuentes
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Liz Cameron
- Faculty of Arts and Education, Geelong Waurn Ponds Campus, Deakin University, Geelong, VIC, Australia
| | - Gillian S Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
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11
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Mobile apps for self-management in pregnancy: a systematic review. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Smartphone health apps for tobacco Cessation: A systematic review. Addict Behav 2021; 112:106616. [PMID: 32932102 DOI: 10.1016/j.addbeh.2020.106616] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given the low retention and lack of persistent support by traditional tobacco cessation programs, evidence-based smartphone app-supported interventions can be an important tobacco control component. The objective of this systematic review was to identify and evaluate the types of studies that use smartphone apps for interventions in tobacco cessation. METHODS We conducted a systematic review of PubMed (1946-2019), EMBASE (1974-2019), and PsycINFO (1806-2019) databases with keywords related to smartphone-supported tobacco cessation. Included articles were required to meet 3 baseline screening criteria: 1) be written in English, 2) include an abstract, and 3) be a full, peer-reviewed manuscript. The criteria for the second level of review were: 1) primary outcome of tobacco cessation, 2) intervention study, and 3) smartphone app as primary focus of study. RESULTS Of 1973 eligible manuscripts, 18 met inclusion criteria. Most studies (n = 17) recruited adult participants (18 + years); one included teens (16 + years). Tobacco cessation was usually self-reported (n = 11), compared to biochemical verification (n = 3) or both (n = 4). There were 11 randomized controlled trials, 4 of which reported statistically significant results, and 7 single-arm trials that reported a mean abstinence rate of 33.9%. DISCUSSION The majority of studies that use tobacco cessation apps as an intervention delivery modality are mostly at the pilot/feasibility stage. The growing field has resulted in studies that varied in methodologies, study design, and inclusion criteria. More consistency in intervention components and larger randomized controlled trials are needed for tobacco cessation smartphone apps.
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13
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Bahadoor R, Alexandre JM, Fournet L, Gellé T, Serre F, Auriacombe M. Inventory and Analysis of Controlled Trials of Mobile Phone Applications Targeting Substance Use Disorders: A Systematic Review. Front Psychiatry 2021; 12:622394. [PMID: 33692708 PMCID: PMC7937918 DOI: 10.3389/fpsyt.2021.622394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Less than 20% of people with addictions have access to adequate treatment. Mobile health could improve access to care. No systematic review evaluates effectiveness of mobile health applications for addiction. Objectives: First aim was to describe controlled trials evaluating the effectiveness of smartphone applications targeting substance use disorders and addictive behaviors. Secondly, we aimed to understand how the application produced changes in behavior and craving management. Method: A systematic review based on PRISMA recommendations was conducted on MEDLINE, CENTRAL, and PsycINFO. Studies had to be controlled trials concerning addictive disorders (substance/behavior), mobile application-based interventions, assessing effectiveness or impact of those applications upon use, published after 2008. Relevant information was systematically screened for synthesis. Quality and risk of bias were evaluated with JADAD score. Results: Search strategy retrieved 22 articles (2014-2019) corresponding to 22 applications targeting tobacco, alcohol, other substances and binge eating disorder. Control groups had access to usual treatments or a placebo-application or no treatment. Eight applications showed reduced use. Most of the applications informed about risks of use and suggestions for monitoring use. Twelve applications managed craving. Discussion: Heterogeneity limited study comparisons. Duration of studies was too short to predict sustainable results. A reduction of craving seemed related to a reduction in use. Conclusion: There is a lack of robust and comparable studies on mHealth applications for addiction treatment. Such applications could become significant contributors in clinical practice in the future so longer-termed double-blind studies are needed. Targeting craving to prevent relapse should be systematic.
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Affiliation(s)
- Rubaab Bahadoor
- University of Bordeaux, Bordeaux, France.,Addiction Team Phenomenology and Determinants of Appetitive Behaviors, Sanpsy CNRS USR 3413, Bordeaux, France
| | - Jean-Marc Alexandre
- University of Bordeaux, Bordeaux, France.,Addiction Team Phenomenology and Determinants of Appetitive Behaviors, Sanpsy CNRS USR 3413, Bordeaux, France.,Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Lucie Fournet
- University of Bordeaux, Bordeaux, France.,Addiction Team Phenomenology and Determinants of Appetitive Behaviors, Sanpsy CNRS USR 3413, Bordeaux, France.,Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Thibaut Gellé
- University of Bordeaux, Bordeaux, France.,Addiction Team Phenomenology and Determinants of Appetitive Behaviors, Sanpsy CNRS USR 3413, Bordeaux, France.,Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Fuschia Serre
- University of Bordeaux, Bordeaux, France.,Addiction Team Phenomenology and Determinants of Appetitive Behaviors, Sanpsy CNRS USR 3413, Bordeaux, France.,Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, Bordeaux, France.,Addiction Team Phenomenology and Determinants of Appetitive Behaviors, Sanpsy CNRS USR 3413, Bordeaux, France.,Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France.,Department of Psychiatry, Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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14
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Kurti AN, Tang K, Bolivar HA, Evemy C, Medina N, Skelly J, Nighbor T, Higgins ST. Smartphone-based financial incentives to promote smoking cessation during pregnancy: A pilot study. Prev Med 2020; 140:106201. [PMID: 32652133 PMCID: PMC7680385 DOI: 10.1016/j.ypmed.2020.106201] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/13/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
Cigarette smoking during pregnancy increases risk for pregnancy complications, growth restriction, and other adverse health outcomes. The most effective intervention for reducing smoking during pregnancy is financial incentives contingent on biochemically-verified smoking abstinence. The present study examined the efficacy of a smartphone-based intervention whereby smoking monitoring and incentive delivery occurred remotely using a mobile app. If efficacious, this remote intervention would allow pregnant women residing in geographically remote areas to benefit from incentives-based cessation interventions. Sixty U.S. pregnant smokers were recruited between May 2018 to May 2019 via obstetrical clinics, Women, Infants, and Children (WIC) offices, and Facebook. Participants were assigned sequentially to one of two treatments: best practices alone (N = 30) or best practices plus financial incentives (N = 30). Outcomes were analyzed using repeated measures analysis based on generalized estimating equations (GEE). Seven-day point prevalence abstinence rates were greater in the incentives versus best practices arms early- (46.7% vs 20.0%, OR = 3.50, 95%CI = 1.11,11.02) and late-antepartum (36.7% vs 13.3%, OR = 3.76, 95%CI = 1.04,13.65), and four- (36.7% vs 10.0%, OR = 5.21, 95%CI = 1.28,21.24) and eight-weeks postpartum (40.0% vs 6.7%, OR = 9.33, 95%CI = 1.87,46.68), although not at the 12- (23.3% vs 10.0%, OR = 2.74, 95%CI = 0.63,11.82) or 24-week (20.0% vs 6.7%, OR = 3.50, 95%CI = 0.65,18.98) postpartum assessments likely due to this pilot study being underpowered for discerning differences at the later assessments, especially 24-weeks postpartum which was three months after treatment completion. These results support the efficacy of this remote, incentives-based intervention for pregnant smokers. Further research evaluating its efficacy and cost-effectiveness in a well-powered, randomized controlled trial appears warranted.
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Affiliation(s)
- Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA.
| | - Katherine Tang
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Hypatia A Bolivar
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Carolyn Evemy
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
| | - Norman Medina
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Joan Skelly
- Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Tyler Nighbor
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
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15
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O’Dea B, Han J, Batterham PJ, Achilles MR, Calear AL, Werner‐Seidler A, Parker B, Shand F, Christensen H. A randomised controlled trial of a relationship-focussed mobile phone application for improving adolescents' mental health. J Child Psychol Psychiatry 2020; 61:899-913. [PMID: 32683737 PMCID: PMC7496128 DOI: 10.1111/jcpp.13294] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/17/2020] [Accepted: 06/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study evaluated the acceptability and effectiveness of a relationship-focussed mobile phone application (WeClick) for improving depressive symptoms and other mental health outcomes in adolescents. METHODS A randomised controlled trial involving 193 youth (M age: 14.82, SD: 0.94, 86.5% female) from Australia was conducted. Youth were recruited via the Internet and randomly allocated to the intervention or a 4-week wait list control condition, stratified for age and gender. The primary outcome was change in depressive symptom scores measured using the Patient Health Questionnaire for Adolescents (PHQ-A) at baseline, 4-week post-test and 12-week follow-up. Secondary outcomes included anxiety, psychological distress, wellbeing, help-seeking intentions for mental health, social self-efficacy and social support. Participants in the intervention condition received access to the intervention for four weeks. Thematic analysis was utilised to identify and examine acceptability. RESULTS The change in PHQ-A scores from baseline to 4-week post-test did not differ significantly (d = 0.26, p = .138) between the intervention (Mchange = -2.9, SD = 5.3) and wait list control conditions (Mchange = -1.7, SD = 4.3). However, significant between-group improvements were observed in wellbeing (d = 0.37, p = .023), help-seeking intentions (d = 0.36, p = .016) and professional help-seeking intentions for mental health problems (d = 0.36, p = .008). Increases in help-seeking intentions were sustained at follow-up in the intervention condition. No differential effects were found for generalised anxiety, separation anxiety, social self-efficacy or for any social support outcomes. Over 90% of participants indicated the app was enjoyable, interesting and easy to use. The app provided 'advice and direction' (n = 42; 46.15%), an 'opportunity for self-reflection' (n = 33; 36.3%) and 'normalised experiences' (n = 21; 23.1%). CONCLUSIONS The WeClick app was found to be effective for improving wellbeing and help-seeking intentions for mental health in adolescents. A larger, adequately powered trial is now required to establish differential effects on depressive symptoms. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001982202.
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Affiliation(s)
- Bridianne O’Dea
- Black Dog InstituteFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Jin Han
- Black Dog InstituteFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Philip J. Batterham
- Center for Mental Health ResearchResearch School of Population HealthThe Australian National UniversityCanberraACTAustralia
| | - Melinda R. Achilles
- Black Dog InstituteFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Alison L. Calear
- Center for Mental Health ResearchResearch School of Population HealthThe Australian National UniversityCanberraACTAustralia
| | - Aliza Werner‐Seidler
- Black Dog InstituteFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Belinda Parker
- Black Dog InstituteFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Fiona Shand
- Black Dog InstituteFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Helen Christensen
- Black Dog InstituteFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
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16
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Dascal M, Rusu A, Onisor A, Blaga O, Miller M, Meghea C. An mHealth intervention to prevent postnatal smoking relapse: The RESPREMO study protocol. Tob Prev Cessat 2020; 6:24. [PMID: 32548361 PMCID: PMC7291910 DOI: 10.18332/tpc/118724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/21/2022]
Abstract
Up to 70% of women who quit smoking relapse after birth, usually within 3 months postpartum. The wide adoption of mobile technologies, especially smartphones, in recent years in low- and middle-income countries (LMICs) offers the possibility of low-cost, novel, and innovative mobile phone-based interventions for smoking relapse prevention. This study presents the protocol of the RESPREMO clinical trial for postnatal smoking relapse prevention for enrolled women, who recently gave birth and quit tobacco smoking before or during pregnancy, and their life partners. This work relies on data collected in two of the largest government-owned obstetrics and gynecology clinics in Cluj-Napoca, Romania. Seventy-five couples were randomized into one of three groups: a) 24 couples were allocated to the first intervention group and asked to install and use the xSmoker app; b) 26 couples were randomized to the second intervention group, who, in addition to the use of the xSmoker app, received text messages with content focused on motivation, problem solving, and dyadic efficacy; and c) 25 couples were randomized into a control group. Several measures of engagement with the xSmoker app were assessed, including duration of app use, the frequency of utilizing the tool to calculate savings from quitting, number of app-delivered challenges accepted by users, and number of app-delivered cessation and abstinence tips. If effective, RESPREMO is expected to have a sustainable impact on the prevention of postnatal relapse tobacco smoking with positive effects for both the mother and the newborn. The implications are beyond tobacco control, and relevant to the design and implementation of other mHealth behavioral interventions focused on the pregnancy and reproductive years in general.
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Affiliation(s)
- Marina Dascal
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Andreea Rusu
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Alexandra Onisor
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Oana Blaga
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Mckenzie Miller
- College of Human Medicine, Michigan State University, East Lansing, United States
| | - Cristian Meghea
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, United States
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17
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Hussain T, Smith P, Yee LM. Mobile Phone-Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e15111. [PMID: 32463373 PMCID: PMC7290451 DOI: 10.2196/15111] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/22/2019] [Accepted: 01/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions In high-income countries, utilization of mobile phone–based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain.
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Affiliation(s)
- Tasmeen Hussain
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Patricia Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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18
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Vilardaga R, Casellas-Pujol E, McClernon JF, Garrison KA. Mobile Applications for the Treatment of Tobacco Use and Dependence. CURRENT ADDICTION REPORTS 2019; 6:86-97. [PMID: 32010548 PMCID: PMC6994183 DOI: 10.1007/s40429-019-00248-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Smoking remains a leading preventable cause of premature death in the world; thus, developing effective and scalable smoking cessation interventions is crucial. This review uses the Obesity-Related Behavioral Intervention Trials (ORBIT) model for early phase development of behavioral interventions to conceptually organize the state of research of mobile applications (apps) for smoking cessation, briefly highlight their technical and theory-based components, and describe available data on efficacy and effectiveness. RECENT FINDINGS Our review suggests that there is a need for more programmatic efforts in the development of mobile applications for smoking cessation, though it is promising that more studies are reporting early phase research such as user-centered design. We identified and described the app features used to implement smoking cessation interventions, and found that the majority of the apps studied used a limited number of mechanisms of intervention delivery, though more effort is needed to link specific app features with clinical outcomes. Similar to earlier reviews, we found that few apps have yet been tested in large well-controlled clinical trials, although progress is being made in reporting transparency with protocol papers and clinical trial registration. SUMMARY ORBIT is an effective model to summarize and guide research on smartphone apps for smoking cessation. Continued improvements in early phase research and app design should accelerate the progress of research in mobile apps for smoking cessation.
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Affiliation(s)
- Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Erwin Terrace Building II, 2812 Erwin Rd, Box 13, Durham, NC 27705, USA
| | - Elisabet Casellas-Pujol
- Department of Psychiatry, Hospital Santa Creu I Sant Pau, Carrer de Sant Quinti, 89, 08041 Barcelona, Spain
| | - Joseph F. McClernon
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Kathleen A. Garrison
- Department of Psychiatry, Yale School of Medicine, 1 Church Street, Suite 730, New Haven, CT 06510, USA
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19
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Marin-Gomez FX, Garcia-Moreno Marchán R, Mayos-Fernandez A, Flores-Mateo G, Granado-Font E, Barrera Uriarte ML, Duch J, Rey-Reñones C. Exploring Efficacy of a Serious Game (Tobbstop) for Smoking Cessation During Pregnancy: Randomized Controlled Trial. JMIR Serious Games 2019; 7:e12835. [PMID: 30916655 PMCID: PMC6456830 DOI: 10.2196/12835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background Tobacco use during pregnancy entails a serious risk to the mother and harmful effects on the development of the child. Europe has the highest tobacco smoking prevalence (19.3%) compared with the 6.8% global mean. Between 20% to 30% of pregnant women used tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on the risks associated with tobacco use during pregnancy. Objective The aim of this study was to investigate the efficacy of an intervention that incorporates a serious game (Tobbstop) to help pregnant smokers quit smoking. Methods A two-arm randomized controlled trial enrolled 42 women who visited 2 primary care centers in Catalonia, Spain, between March 2015 and November 2016. All participants were pregnant smokers, above 18 years old, attending consultation with a midwife during the first trimester of pregnancy, and had expressed their desire to stop smoking. Participants were randomized to the intervention (n=21) or control group (n=21). The intervention group was instructed to install the game on their mobile phone or tablet and use it for 3 months. Until delivery, all the participants were assessed on their stage of smoking cessation during their follow-up midwife consultations. The primary outcome was continuous tobacco abstinence until delivery confirmed by the amount of carbon monoxide at each visit, measured with a carboxymeter. Results Continuous abstinence until delivery outcome was 57% (12/21) in the intervention group versus 14% (3/21) in the control group (hazard ratio=4.31; 95% CI 1.87-9.97; P=.001). The mean of total days without smoking until delivery was higher in the intervention group (mean 139.75, SD 21.76) compared with the control group (mean 33.28, SD 13.27; P<.001). In addition, a Kapplan-Meier survival analysis showed that intervention group has a higher abstinence rate compared with the control group (log-rank test, χ21=13.91; P<.001). Conclusions Serious game use is associated with an increased likelihood to maintain abstinence during the intervention period if compared with those not using the game. Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games are an emerging technology, growing in importance, which are shown to be a good tool to help quitting smoking during pregnancy and also to maintain this abstinent behavior. However, because of the study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study. Trial Registration ClinicalTrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421 (Archived by WebCite at http://www.webcitation.org/75ISc59pB)
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Affiliation(s)
- Francesc X Marin-Gomez
- Servei d'Atenció Primària d'Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Vic, Spain.,Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Digital Care Research Group, Universitat de Vic-Universitat Central de Catalunya, Centre for Health and Social Care Research, Vic, Spain
| | - Rocio Garcia-Moreno Marchán
- Sexual and Reproductive Health Unit, Servei d'Atenció Primària d'Osona, Institut Català de la Salut, Vic, Spain
| | - Anabel Mayos-Fernandez
- Sexual and Reproductive Health Unit, Servei d'Atenció Primària d'Osona, Institut Català de la Salut, Vic, Spain
| | - Gemma Flores-Mateo
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Unitat d'Anàlisi i Qualitat, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - Esther Granado-Font
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Departament d'Infermeria, Facultat d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain.,Centre d'Atenció Primària Horts de Miró (Reus-4), Gerència d'Àmbit d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Maria Luisa Barrera Uriarte
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Centre d'Atenció Primària La Granja (Tarragona-2), Gerència d'Àmbit d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Torreforta, Tarragona, Spain
| | - Jordi Duch
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Cristina Rey-Reñones
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Departament d'Infermeria, Facultat d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
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Crane D, Ubhi HK, Brown J, West R. Relative effectiveness of a full versus reduced version of the 'Smoke Free' mobile application for smoking cessation: an exploratory randomised controlled trial. F1000Res 2018; 7:1524. [PMID: 30728950 PMCID: PMC6347038 DOI: 10.12688/f1000research.16148.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Smartphone applications (apps) are popular aids for smoking cessation. Smoke Free is an app that delivers behaviour change techniques used in effective face-to-face behavioural support programmes. The aim of this study was to assess whether the full version of Smoke Free is more effective than the reduced version. Methods: This was a two-arm exploratory randomised controlled trial. Smokers who downloaded Smoke Free were randomly offered the full or reduced version; 28,112 smokers aged 18+ years who set a quit date were included. The full version provided updates on benefits of abstinence, progress (days smoke free), virtual 'badges' and daily 'missions' with push notifications aimed at preventing and managing cravings. The reduced version did not include the missions. At baseline the app recorded users': device type (iPhone or Android), age, sex, daily cigarette consumption, time to first cigarette of the day, and educational level. The primary outcome was self-reported complete abstinence from the quit date in a 3-month follow-up questionnaire delivered via the app. Analyses conducted included logistic regressions of outcome on to app version (full versus reduced) with adjustment for baseline variables using both intention-to-treat/missing-equals smoking (MES) and follow-up-only (FUO) analyses. Results: The 3-month follow-up rate was 8.5% (n=1,213) for the intervention and 6.5% (n=901) for the control. A total of 234 participants reported not smoking in the intervention versus 124 in the control, representing 1.6% versus 0.9% in the MES analysis and 19.3% versus 13.8% in the FUO analysis. Adjusted odds ratios were 1.90, 95%CI=1.53-2.37 (p<0.001) and 1.50, 95%CI=1.18-1.91 (p<0.001) in the MES and FUO analyses respectively. Conclusions: Despite very low follow-up rates using in-app follow up, both intention-to-treat/missing equals smoking and follow-up only analyses showed the full version of the Smoke Free app to result in higher self-reported 3-month continuous smoking abstinence rates than the reduced version.
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Affiliation(s)
- David Crane
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Harveen Kaur Ubhi
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
- National Centre for Smoking Cessation and Training, Dorchester, DT1 1RD, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
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Crane D, Ubhi HK, Brown J, West R. Relative effectiveness of a full versus reduced version of the 'Smoke Free' mobile application for smoking cessation: a randomised controlled trial. F1000Res 2018; 7:1524. [PMID: 30728950 PMCID: PMC6347038 DOI: 10.12688/f1000research.16148.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 08/01/2023] Open
Abstract
Background: Smartphone applications (apps) are popular aids for smoking cessation. Smoke Free is an app that delivers behaviour change techniques used in effective face-to-face behavioural support programmes. The aim of this study was to assess whether the full version of Smoke Free is more effective than the reduced version. Methods: This was a two-arm randomised controlled trial. Smokers who downloaded Smoke Free were randomly offered the full or reduced version; 28,112 smokers aged 18+ years who set a quit date were included. The full version provided updates on benefits of abstinence, progress (days smoke free), virtual 'badges' and daily 'missions' with push notifications aimed at preventing and managing cravings. The reduced version did not include the missions. At baseline the app recorded users': device type (iPhone or Android), age, sex, daily cigarette consumption, time to first cigarette of the day, and educational level. The primary outcome was self-reported complete abstinence from the quit date in a 3-month follow-up questionnaire delivered via the app. Analyses conducted included logistic regressions of outcome on to app version (full versus reduced) with adjustment for baseline variables using both intention-to-treat/missing-equals smoking (MES) and follow-up-only (FUO) analyses. Results: The 3-month follow-up rate was 8.5% (n=1,213) for the intervention and 6.5% (n=901) for the control. A total of 234 participants reported not smoking in the intervention versus 124 in the control, representing 1.6% versus 0.9% in the MES analysis and 19.3% versus 13.8% in the FUO analysis. Adjusted odds ratios were 1.90, 95%CI=1.53-2.37 (p<0.001) and 1.50, 95%CI=1.18-1.91 (p<0.001) in the MES and FUO analyses respectively. Conclusions: Despite very low follow-up rates using in-app follow up, both intention-to-treat/missing equals smoking and follow-up only analyses showed the full version of the Smoke Free app to result in higher self-reported 3-month continuous smoking abstinence rates than the reduced version.
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Affiliation(s)
- David Crane
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Harveen Kaur Ubhi
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
- National Centre for Smoking Cessation and Training, Dorchester, DT1 1RD, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
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