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Rupp A, Rietzler S, Di Lellis MA, Weiland T, Tschirner C, Kreuter M. Digital Smoking Cessation With a Comprehensive Guideline-Based App-Results of a Nationwide, Multicentric, Parallel, Randomized Controlled Trial in Germany. Nicotine Tob Res 2024; 26:895-902. [PMID: 38243574 DOI: 10.1093/ntr/ntae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Smoking tobacco implies significant health hazards. Digital cessation support can get more smokers in contact with guideline-based cessation. The objective was to test the efficacy of a guideline-based smoking cessation app (NichtraucherHelden®). The hypothesis was a significantly higher cessation rate in the intervention group. METHODS The study was a nationwide, multicentric, prospective, parallel, randomized controlled trial in Germany from November 2021 to March 2023. Recruitment took place in medical practices and by telephone via study centers. Eligible participants were adult tobacco-dependent smokers according to ICD-10 (F17.2). Randomization (1:1) was operated by a computer-generated stratified 1:1 block procedure. Intervention (IG; n = 336) and control group (CG; n = 325) were briefly advised with regard to stop smoking, IG was additionally treated with the cessation app. The primary endpoint was the self-reported 7-day-point abstinence after 6 months with an intention to treat analysis. Secondary endpoints comprised prolonged abstinence and biochemically verified abstinence. The study was registered at the German Registry of Clinical Trials (DRKS00025933, UTN U1111-1268-2181) and was approved by the competent ethics committees (leading ethic committee Berlin #Eth-52/20). RESULTS Three hundred thirty six participants (IG) and 325 (CG) were analyzed. Seven-day point prevalence was significantly higher in the app group (IG) (20% vs. 10%, OR 2.2 (1.4-3.4)). Additionally, the prolonged abstinence and the objective abstinence rates were significantly higher in the app group. CONCLUSIONS The NichtraucherHelden app doubles the abstinence rate. Apps can bridge the gap between the small number of therapeutic offers and the need for modern evidence-based cessation support. IMPLICATIONS The study is the first to provide evidence for the feasibility and efficacy of guideline-based digital smoking cessation provided by a smartphone app for the German statutory health insurance (SHI) system. Smoking cessation support by smartphone apps could be broadly distributed and thus bring more smokers in contact with guideline-based cessation support than to date and increase the number of successful quitters substantially.
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Affiliation(s)
- Alexander Rupp
- Outpatient Clinic for Pulmonary Medicine (Pneumologische Praxis im Zentrum (PiZ)), Stuttgart, Germany
| | | | | | | | | | - Michael Kreuter
- Department of Pneumology, Mainz Centre for Pulmonary Medicine, Mainz University Medical Centre and Department of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Klinikum Mainz, Mainz, Germany
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Andree R, Mujcic A, den Hollander W, van Laar M, Boon B, Engels R, Blankers M. Digital Smoking Cessation Intervention for Cancer Survivors: Analysis of Predictors and Moderators of Engagement and Outcome Alongside a Randomized Controlled Trial. JMIR Cancer 2024; 10:e46303. [PMID: 38901028 DOI: 10.2196/46303] [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: 02/07/2023] [Revised: 01/26/2024] [Accepted: 02/25/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Recent studies have shown positive, though small, clinical effects of digital smoking cessation (SC) interventions for cancer survivors. However, research on associations among participant characteristics, intervention engagement, and outcomes is limited. OBJECTIVE This study aimed to explore the predictors and moderators of engagement and outcome of MyCourse-Quit Smoking (in Dutch: "MijnKoers-Stoppen met Roken"), a digital minimally guided intervention for cancer survivors. METHODS A secondary analysis of data from the randomized controlled trial was performed. The number of cigarettes smoked in the past 7 days at 6-month follow-up was the primary outcome measure. We analyzed interactions among participant characteristics (11 variables), intervention engagement (3 variables), and outcome using robust linear (mixed) modeling. RESULTS In total, 165 participants were included in this study. Female participants accessed the intervention less often than male participants (B=-11.12; P=.004). A higher Alcohol Use Disorders Identification Test score at baseline was associated with a significantly higher number of logins (B=1.10; P<.001) and diary registrations (B=1.29; P<.001). A higher Fagerström Test for Nicotine Dependence score at baseline in the intervention group was associated with a significantly larger reduction in tobacco use after 6 months (B=-9.86; P=.002). No other associations and no moderating effects were found. CONCLUSIONS Overall, a limited number of associations was found between participant characteristics, engagement, and outcome, except for gender, problematic alcohol use, and nicotine dependence. Future studies are needed to shed light on how this knowledge can be used to improve the effects of digital SC programs for cancer survivors. TRIAL REGISTRATION Netherlands Trial register NTR6011/NL5434; https://onderzoekmetmensen.nl/nl/trial/22832.
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Affiliation(s)
- Rosa Andree
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Ajla Mujcic
- PsyQ, Parnassia Groep, The Hague, Netherlands
| | - Wouter den Hollander
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Margriet van Laar
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Brigitte Boon
- Siza, Center for Long-term Care for People with Disabilities, Arnhem, Netherlands
- Academy Het Dorp, Research & Advisory on Technology in Long-term Care, Arnhem, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Rutger Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
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Coleman C, Ferguson SG, Nash R. Barriers to smoking interventions in community healthcare settings: a scoping review. Health Promot Int 2024; 39:daae036. [PMID: 38666785 PMCID: PMC11046987 DOI: 10.1093/heapro/daae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Smoking is one of the major causes of preventable death and is considered the greatest threat to global public health. While the prevalence of smoking has decreased, population growth has led to an increase in the absolute number of smokers. There are many proven smoking cessation interventions available to support smokers in their quit attempts. Most people who smoke, however, underutilize the treatments available to them. This scoping review aimed to identify the current barriers experienced by all stakeholders (smokers, service providers and policymakers) to existing evidence-based smoking cessation interventions in community healthcare settings. Five electronic databases (CINAHL, Ovid MEDLINE, PsycINFO, Scopus and Web of Science) were searched for relevant literature. A total of 40 eligible articles from different countries published between 2015 and 2022 were included in the review and content analysis carried out to identify the key barriers to smoking cessation interventions. Seven key themes were found to be common to all stakeholders: (i) literacy, (ii) competing demands and priorities, (iii) time, (iv) access to product, (v) access to service, (vi) workforce and (vii) motivation/readiness. These themes were mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. This study presents the effect the barriers within these themes have on current smoking cessation services and highlights priorities for future interventions.
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Affiliation(s)
- Cheryn Coleman
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia
| | - Stuart G Ferguson
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia
| | - Rosie Nash
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia
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Johansson M, Romero D, Jakobson M, Heinemans N, Lindner P. Digital interventions targeting excessive substance use and substance use disorders: a comprehensive and systematic scoping review and bibliometric analysis. Front Psychiatry 2024; 15:1233888. [PMID: 38374977 PMCID: PMC10875034 DOI: 10.3389/fpsyt.2024.1233888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Addictive substances are prevalent world-wide, and their use presents a substantial and persistent public health problem. A wide range of digital interventions to decrease use and negative consequences thereof have been explored, differing in approach, theoretical grounding, use of specific technologies, and more. The current study was designed to comprehensively map the recent (2015-2022) extant literature in a systematic manner, and to identify neglected and emerging knowledge gaps. Four major databases (Medline, Web of Science Core Collection, and PsychInfo) were searched using database-specific search strategies, combining terms related to clinical presentation (alcohol, tobacco or other drug use), technology and aim. After deduplication, the remaining n=13,917 unique studies published were manually screened in two stages, leaving a final n=3,056 studies, the abstracts of which were subjected to a tailored coding scheme. Findings revealed an accelerating rate of publications in this field, with randomized trials being the most common study type. Several meta-analyses on the topic have now been published, revealing promising and robust effects. Digital interventions are being offered on numerous levels, from targeted prevention to specialized clinics. Detailed coding was at times made difficult by inconsistent use of specific terms, which has important implications for future meta-analyses. Moreover, we identify several gaps in the extant literature - few health economic assessments, unclear descriptions of interventions, weak meta-analytic support for some type of interventions, and limited research on many target groups, settings and new interventions like video calls, chatbots and artificial intelligence - that we argue are important to address in future research.
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Affiliation(s)
- Magnus Johansson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Danilo Romero
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Miriam Jakobson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nelleke Heinemans
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Philip Lindner
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Maiwald P, Bischoff M, Lindinger P, Tinsel I, Sehlbrede M, Fichtner UA, Metzner G, Schlett C, Farin-Glattacker E. The Effect of Interactivity, Tailoring, and Use Intensity on the Effectiveness of an Internet-Based Smoking Cessation Intervention Over a 12-Month Period: Randomized Controlled Trial. J Med Internet Res 2023; 25:e47463. [PMID: 37988144 PMCID: PMC10698653 DOI: 10.2196/47463] [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: 04/13/2023] [Revised: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND eHealth approaches show promising results for smoking cessation (SC). They can improve quit rates, but rigorous research is sparse regarding their effectiveness and the effects of their interactivity, tailoring, and use intensity. OBJECTIVE We examined the effectiveness of Techniker Krankenkasse Smoking Cessation Coaching (TK-SCC), an internet-based, tailored, and interactive SC intervention. Our hypotheses were as follows: hypothesis 1, in the intervention group (IG; access to TK-SCC), a clinically relevant number of participants will be abstinent at the 12-month follow-up (T3); hypothesis 2, the number of abstinent participants will be significantly greater in the IG than the control group (CG) at T3; and hypothesis 3, in the IG, more intense use of TK-SCC will be positively associated with abstinence. METHODS Individuals who smoke were randomized into the IG (563/1115, 50.49%) or CG (552/1115, 49.51%), which received a noninteractive, nontailored, and information-only web-based intervention. Data were collected before the intervention, at the postintervention time point (T1), at the 4-month follow-up (T2), and at T3. We tested hypothesis 1 through equivalence tests between the IG's success rate and success rates of comparable effective interventions reported in 2 current meta-analyses. For hypothesis 2, we conducted binary logistic regressions. For hypothesis 3, we assigned the IG participants to 1 of 4 user types and used binary logistic regressions with user types as the independent variable and smoking abstinence as the dependent variable. RESULTS In the IG, 11.5% (65/563) and 11.9% (67/563) of participants were smoke free at T1 and T3, respectively. These values were statistically equivalent to the effects in the 2 meta-analyses, which reported 9% (z score=0.64, P=.74) and 10.9% (z score=-0.71, P=.24) success rates, respectively. In the CG, 6.2% (34/552) of the participants were smoke free at T1, which increased up to 8.2% (45/552) at T3. The difference between the IG and CG was statistically significant only at T1 (odds ratio [OR] 2.0, 99% CI 1.1 to 3.6; P=.002), whereas the effect was nonsignificant following α error corrections at T3 (OR 1.6, 99% CI 0.9 to 2.7; P=.02). In the IG, constant users of the program became smoke free significantly more often than rare users of the program (T1: OR 15.0, 99% CI 6.1 to 36.9; P<.001; T3: OR 6.5, 99% CI 2.8 to 15.5; P<.001). CONCLUSIONS TK-SCC is effective for SC. However, its superiority compared with a minimal SC intervention could not be confirmed in the long term. Insufficient implementation of the techniques used and cotreatment bias could explain this outcome. Higher use intensity of TK-SCC was positively related to abstinence. Therefore, additional efforts to motivate users to adhere to intervention use as intended could improve the intervention's effectiveness. TRIAL REGISTRATION German Clinical Trials Register DRKS00020249, Universal Trial Number U1111-1245-0273; https://drks.de/search/de/trial/DRKS00020249. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-021-05470-8.
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Affiliation(s)
- Phillip Maiwald
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martina Bischoff
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Lindinger
- Wissenschaftlicher Arbeitskreis Tabakentwöhnung (WAT) e V, Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen, Germany
| | - Iris Tinsel
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Sehlbrede
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Urs Alexander Fichtner
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Gloria Metzner
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christian Schlett
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Nian T, Guo K, Liu W, Deng X, Hu X, Xu M, E F, Wang Z, Song G, Yang K, Li X, Shang W. Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses. BMC Med 2023; 21:378. [PMID: 37775745 PMCID: PMC10542700 DOI: 10.1186/s12916-023-03087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs. METHODS A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size. RESULTS A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating. CONCLUSIONS The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).
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Affiliation(s)
- Tao Nian
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Kangle Guo
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wendi Liu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xinxin Deng
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xiaoye Hu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Meng Xu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Fenfen E
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Ziyi Wang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Guihang Song
- Gansu Provincial Medical Security Bureau, Lanzhou, 730000, People's Republic of China
| | - Kehu Yang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Xiuxia Li
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wenru Shang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Collaborative Innovation Center of First Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.
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Fang YE, Zhang Z, Wang R, Yang B, Chen C, Nisa C, Tong X, Yan LL. Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e45111. [PMID: 37505802 PMCID: PMC10422176 DOI: 10.2196/45111] [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: 12/16/2022] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Rapid advancements in eHealth and mobile health (mHealth) technologies have driven researchers to design and evaluate numerous technology-based interventions to promote smoking cessation. The evolving nature of cessation interventions emphasizes a strong need for knowledge synthesis. OBJECTIVE This systematic review and meta-analysis aimed to summarize recent evidence from randomized controlled trials regarding the effectiveness of eHealth-based smoking cessation interventions in promoting abstinence and assess nonabstinence outcome indicators, such as cigarette consumption and user satisfaction, via narrative synthesis. METHODS We searched for studies published in English between 2017 and June 30, 2022, in 4 databases: PubMed (including MEDLINE), PsycINFO, Embase, and Cochrane Library. Two independent reviewers performed study screening, data extraction, and quality assessment based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We pooled comparable studies based on the population, follow-up time, intervention, and control characteristics. Two researchers performed an independent meta-analysis on smoking abstinence using the Sidik-Jonkman random-effects model and log risk ratio (RR) as the effect measurement. For studies not included in the meta-analysis, the outcomes were narratively synthesized. RESULTS A total of 464 studies were identified through an initial database search after removing duplicates. Following screening and full-text assessments, we deemed 39 studies (n=37,341 participants) eligible for this review. Of these, 28 studies were shortlisted for meta-analysis. According to the meta-analysis, SMS or app text messaging can significantly increase both short-term (3 months) abstinence (log RR=0.50, 95% CI 0.25-0.75; I2=0.72%) and long-term (6 months) abstinence (log RR=0.77, 95% CI 0.49-1.04; I2=8.65%), relative to minimal cessation support. The frequency of texting did not significantly influence treatment outcomes. mHealth apps may significantly increase abstinence in the short term (log RR=0.76, 95% CI 0.09-1.42; I2=88.02%) but not in the long term (log RR=0.15, 95% CI -0.18 to 0.48; I2=80.06%), in contrast to less intensive cessation support. In addition, personalized or interactive interventions showed a moderate increase in cessation for both the short term (log RR=0.62, 95% CI 0.30-0.94; I2=66.50%) and long term (log RR=0.28, 95% CI 0.04-0.53; I2=73.42%). In contrast, studies without any personalized or interactive features had no significant impact. Finally, the treatment effect was similar between trials that used biochemically verified or self-reported abstinence. Among studies reporting outcomes besides abstinence (n=20), a total of 11 studies reported significantly improved nonabstinence outcomes in cigarette consumption (3/14, 21%) or user satisfaction (8/19, 42%). CONCLUSIONS Our review of 39 randomized controlled trials found that recent eHealth interventions might promote smoking cessation, with mHealth being the dominant approach. Despite their success, the effectiveness of such interventions may diminish with time. The design of more personalized interventions could potentially benefit future studies. TRIAL REGISTRATION PROSPERO CRD42022347104; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347104.
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Affiliation(s)
- Yichen E Fang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Zhixian Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Ray Wang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Bolu Yang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Chen Chen
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China
| | - Claudia Nisa
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Division of Social Sciences, Duke Kunshan University, Kunshan, China
| | - Xin Tong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Data Science Research Center, Duke Kunshan University, Kunshan, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Institute for Global Health and Development, Peking University, Beijing, China
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Ma Y, Zhou M, Yu W, Zou Z, Ge P, Ma ZF, Tong Y, Li W, Li Q, Li Y, Zhu S, Sun X, Wu Y. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) and e-health literacy(e-HL) to investigate the tobacco control intentions and behaviors of non-smoking college students in China: a cross-sectional investigation. BMC Public Health 2023; 23:765. [PMID: 37098499 PMCID: PMC10127360 DOI: 10.1186/s12889-023-15644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/10/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Non-smoking college students are starting to smoke in increasing numbers, which shows that their tobacco control situation seems not optimistic. The UTAUT and e-HL are commonly used models and theories to predict health behaviors, while there are few studies on tobacco control. This paper aims to study the influencing factors of tobacco control intention and behavior of non-smoking college students in China by combining the UTAUT and e-HL. METHODS Based on the stratified sampling method, 625 college students from 12 universities were selected. Data were collected using a self-made questionnaire designed based on the UTAUT and e-health literacy scales. Data were analyzed by SPSS 22 and AMOS 26, including descriptive statistics, one-way variance analysis and structural equation model analysis. RESULTS The results of one-way variance analysis showed that there were significant differences in the score of non-smoking college students' tobacco control intention or behavior by hometowns, monthly living expenses, and parents' smoking history. Performance expectancy, effort expectancy, social influence had direct positive effects on behavioral intention. Facilitating condition, behavioral intention had direct positive impacts on use behavior and e-HL had an indirect positive impact on use behavior. CONCLUSIONS The combination of the UTAUT and e-HL can be used as an appropriate framework to predict the influencing factors of non-smoking college students' intention and behavior of tobacco control. Improving performance expectancy, effort expectancy, and e-HL among non-smoking college students, creating positive social environments, and providing facilitating condition are key aspects of increasing their tobacco control intention and behavior. It is also beneficial to promote the implementation of smoke-free campus and smoke-free family projects.
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Affiliation(s)
- Yuanyuan Ma
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Mengxia Zhou
- School of Media and Communication, Shanghai Jiaotong University, Shanghai, 201100, China
| | - Wenli Yu
- School of Foreign Languages, Weifang University of Science and Technology, Shouguang, 262700, China
| | - Ziyue Zou
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Pu Ge
- School of Management, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zheng Feei Ma
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, BS16 1QY, UK
| | - Yuting Tong
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Wei Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qiyu Li
- School of Humanities and Health Management, Jinzhou Medical University, Jinzhou, 121000, China
| | - Yunshan Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Siya Zhu
- School of Foreign Languages, Anhui University of Technology, Anhui, 243000, China
| | - Xinying Sun
- School of Public Health, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China.
| | - Yibo Wu
- School of Public Health, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China.
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9
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Derksen ME, Jaspers MWM, Kunst AE, Fransen MP. Usage of digital, social and goal-setting functionalities to support health behavior change: A mixed methods study among disadvantaged women during or after pregnancy and their healthcare professionals. Int J Med Inform 2023; 170:104981. [PMID: 36603389 DOI: 10.1016/j.ijmedinf.2022.104981] [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: 08/22/2022] [Revised: 11/26/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We aimed to gain insight into how and to what extent social (i.e. private/group chat) and goal-setting (e.g. rewards) functionalities in digital interventions for health behavior change were used by clients and nurses in a preventive care program for disadvantaged women during or after pregnancy, and which factors influenced usage. METHODS We collected quantitative and qualitative data on usage of these functionalities in 'Kindle', a mHealth intervention to prepare for health behavior change. RESULTS We found that nurses (n = 5) and clients (n = 20) scarcely used both functionalities. They sent 862 messages in the social functionality whose security they appreciated, but habitually used WhatsApp likewise. Moreover, nurses were hesitant to let their clients interact in the group chat. Clients formulated 59 personal goals, which they found difficult to do. Nurses rewarded 846 points for clients' progress on goal attainment, but found it hard to determine how many points to reward. Clients and nurses indicated that the functionality made it more fun and easy to discuss clients' personal goals. CONCLUSIONS To conclude, digital, social and goal-setting functionalities were used to a limited extent by nurses and clients, and need optimization before implementation to support disadvantaged groups to change their health behavior.
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Affiliation(s)
- M E Derksen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - M W M Jaspers
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - A E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - M P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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10
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Unger S, Golden SE, Melzer AC, Tanner N, Deepak J, Delorit M, Scott JY, Slatore CG. Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules. Contemp Clin Trials 2022; 121:106908. [PMID: 36087843 DOI: 10.1016/j.cct.2022.106908] [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: 04/19/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION We developed Teachable Moment to Opt-Out of Tobacco (TeaM OUT) as a tobacco treatment intervention based on a foundation of a theoretical model of teachable moments, "naturally occurring life transitions or health events thought to motivate individuals to spontaneously adopt risk-reducing health behaviors". The TeaM OUT intervention combines a teachable moment for patients with newly detected incidental pulmonary nodules with a proactive interactive voice response (IVR) system to increase connections to evidence-based tobacco treatment interventions. METHODS We will perform a convergent, nested observational mixed-methods study utilizing both randomized trial and observational methods to test the effectiveness and generalizability of the TeaM OUT intervention through three aims. AIM 1: Among patients recently diagnosed with a pulmonary nodule, we will utilize a pragmatic, stepped wedge randomized controlled design to evaluate the effectiveness of a proactive, teachable moment-based, tobacco treatment outreach intervention (TeaM OUT) on increasing engagement with tobacco treatment resources compared to Enhanced Usual Care. AIM 2: Using a longitudinal observational design, we will evaluate the association of receipt of the TeaM OUT intervention with seven-day point abstinence prevalence and quit motivation compared to Enhanced Usual Care. AIM 3: Qualitatively elicit perspectives from key stakeholders to inform acceptability and utility, implementation barriers and facilitators, and scalability of the TeaM OUT intervention. DISCUSSION We are hopeful that implementation of TeaM OUT will increase the number of patients who quit using cigarettes with subsequent improvements in their health.
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Affiliation(s)
- Stephanie Unger
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA.
| | - Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota; Minneapolis, MN, USA
| | - Nichole Tanner
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veteran Affairs Hospital, Charleston, SC, USA; Division of Pulmonary, Critical Care, Allergy & Sleep, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - Janaki Deepak
- Division of Pulmonary & Critical Care Medicine, University of Maryland Medical System; Baltimore, MD, USA; Baltimore VA Medical Center; Baltimore, MD, USA
| | - Molly Delorit
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University; Portland, OR, USA
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11
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Colliding Epidemics: Research Gaps and Implementation Science Opportunities for Tobacco Use and HIV/AIDS in Low- and Middle-Income Countries. J Smok Cessat 2022; 2022:6835146. [PMID: 35821759 PMCID: PMC9232349 DOI: 10.1155/2022/6835146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Tobacco use is a leading cause of cancer death among people living with HIV (PLWH) worldwide, and smoking prevalence tends to be higher among PLWH. The burden of both HIV/AIDS and tobacco use is increasingly concentrated in low- and middle-income countries (LMICs), where resources to address these challenges are often limited. However, there has been limited effort to date to integrate tobacco cessation into HIV programs in LMICs. Methods We searched the literature (searching was conducted between October 1 and December 31, 2020) using PubMed including search terms “tobacco” and “HIV” and “cessation” over the past ten years (searching for articles published between December 1, 2010, and December 1, 2020) to identify original research studies on tobacco cessation interventions conducted in LMICs for PLWH. We also conducted an analysis of NCI-funded research grants on tobacco cessation and HIV awarded during fiscal years 2010 to 2020. Results and Discussion. Existing evidence suggests that conventional tobacco cessation treatments may be less effective among PLWH. Moreover, while substantial evidence exists to support a range of cessation interventions, most of this evidence comes from HICs and is only partly applicable to the evolving social, economic, and cultural climate of many LMICs. There is an urgent need to develop, adapt, and implement effective tobacco control and cessation interventions targeted to PLWH in LMICs, as well as to generate evidence from these settings. Implementation science provides tools develop and test strategies to overcome barriers and to integrate and scale up cessation services within existing HIV treatment settings. Conclusion There is a unique opportunity to address HIV and tobacco use in a coordinated way in LMICs by integrating evidence-based tobacco cessation into HIV programs.
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12
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da Silva Teixeira R, Nazareth IF, de Paula LC, do Nascimento Duque GP, Colugnati FAB. Adherence to Computational Technologies for the Treatment of Smoking Cessation: Systematic Review and Meta‐analysis. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Asayut N, Olson PS, Kanjanasilp J, Thanarat P, Senkraigul B, Sittisarn C, Suksawat S. A community pharmacist-led smoking cessation intervention using a smartphone app (PharmQuit): A randomized controlled trial. PLoS One 2022; 17:e0265483. [PMID: 35349576 PMCID: PMC8963551 DOI: 10.1371/journal.pone.0265483] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/01/2022] [Indexed: 01/10/2023] Open
Abstract
WHO supports the harnessing of mobile technologies to improve access to smoking cessation services. As such, this study evaluated the effectiveness of smoking cessation services provided by community pharmacists using PharmQuit compared with standard care. The study was a prospective, multicenter, randomized controlled trial that included 156 participants who were 18 years or older and smoked at least one cigarette daily for a month, were ready to quit, willing to participate, and had a smartphone. The study was performed at seven community pharmacies in three provinces in Thailand. Participants were allocated to the intervention (n = 78) and control groups (n = 78). Both groups received the usual smoking cessation services with pharmacotherapy and counseling from community pharmacists for 6 months. The intervention group received PharmQuit as an additional service. Both groups were scheduled for follow-up visits on days 7, 14, 30, 60, 120, and 180. The primary outcome was continuous abstinence rate on day 180. The secondary outcomes included 7-day point abstinence rate, number of cigarettes smoked per day, exhaled carbon monoxide levels, adherence rate to the program, and satisfaction with PharmQuit. An analysis using the intent-to-treat principle was performed. Smoking cessation rates and the number of cigarettes smoked per day were significantly higher during the follow-up visits in both groups (p < 0.05). However, there were no statistically significant differences between the two groups. The adherence rate to the smoking cessation program was higher in the intervention group than in the control group (74 days vs. 60 days, p > 0.05). The results showed the benefits of the contribution of community pharmacists. Although the inclusion of PharmQuit did not yield better results than pharmacists’ counselling alone, it may help obtain better adherence to smoking cessation programs. Trial registration: Thai Clinical Trials Registry: TCTR20200925004 on September 25, 2020 –retrospectively registered, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=6841.
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Affiliation(s)
- Narong Asayut
- Doctor of Philosophy in Pharmacy Program, Faculty of Pharmacy, Mahasarakham University, Khamriang Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Phayom Sookaneknun Olson
- The International Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Juntip Kanjanasilp
- The Clinical Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Preut Thanarat
- Faculty of Informatics, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Bhattaraporn Senkraigul
- Faculty of Informatics, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Chuthathip Sittisarn
- The International Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Suratsawatee Suksawat
- The International Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
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14
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Portelli P, Bogolyubova O, Tristan Lopez B, Sainz-Maza A. A Quality Review of Smart-Phone Applications for Smoking Cessation. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2022. [DOI: 10.1080/15398285.2021.2021372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pamela Portelli
- Department of Psychology, Faculty for Social Wellbeing, University of Malta, Msida, Malta
| | - Olga Bogolyubova
- Department of Psychology, Faculty for Social Wellbeing, University of Malta, Msida, Malta
| | - Belen Tristan Lopez
- Health and Clinical Psychology Department, Faculty of Psychology, University of Almeria, La Canaria, Almería, Espana
| | - Andrea Sainz-Maza
- Health and Clinical Psychology Department, Faculty of Psychology, University of Almeria, La Canaria, Almería, Espana
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15
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Graham AL, Papandonatos GD, Cha S, Amato MS, Jacobs MA, Cohn AM, Abroms LC, Whittaker R. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022; 117:1035-1046. [PMID: 34472676 PMCID: PMC9293135 DOI: 10.1111/add.15677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. DESIGN A parallel, two-group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow-up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. SETTING United States: a digital study conducted among new registrants on a free tobacco cessation website. PARTICIPANTS Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). INTERVENTIONS The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 9 months post-randomization analyzed under intent to treat (ITT), counting non-responders as smoking. Secondary outcomes included 3-month measures of 30-day ppa, intervention engagement and intervention satisfaction. FINDINGS Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69-1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26-0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). CONCLUSIONS A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9-month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Sarah Cha
- Innovations Center, Truth InitiativeWashingtonDCUSA
| | - Michael S. Amato
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Amy M. Cohn
- Health Promotion Research CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA,Department of Pediatrics, Children's HospitalUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonDCUSA
| | - Robyn Whittaker
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
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16
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Balci S, Spanhel K, Sander LB, Baumeister H. Culturally adapting internet- and mobile-based health promotion interventions might not be worth the effort: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:34. [PMID: 35322172 PMCID: PMC8943001 DOI: 10.1038/s41746-022-00569-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Health promotion interventions offer great potential in advocating a healthy lifestyle and the prevention of diseases. Some barriers to communicating health promotion to people of certain cultural groups might be overcome via the internet- and mobile-based interventions (IMI). This systematic review and meta-analysis aims to explore the effectiveness of culturally adapted IMI for health promotion interventions among culturally diverse populations. We systematically searched on Cochrane Central Register of Controlled Trials (CENTRAL), EbscoHost/MEDLINE, Ovid/Embase, EbscoHost/PsychINFO, and Web of Science databases in October 2020. Out of 9438 records, 13 randomized controlled trials (RCT) investigating culturally adapted health promotion IMI addressing healthy eating, physical activity, alcohol consumption, sexual health behavior, and smoking cessation included. From the included studies 10,747 participants were eligible. Culturally adapted IMI proved to be non-superior over active control conditions in short- (g = 0.10, [95% CI −0.19 to 0.40]) and long-term (g = 0.20, [95% CI −0.11 to 0.51]) in promoting health behavior. However, culturally adapted IMI for physical activity (k = 3, N = 296) compared to active controls yielded a beneficial effect in long-term (g = 0.48, [95%CI 0.25 to 0.71]). Adapting health promotion IMI to the cultural context of different cultural populations seems not yet to be recommendable given the substantial adaption efforts necessary and the mostly non-significant findings. However, these findings need to be seen as preliminary given the limited number of included trials with varying methodological rigor and the partly substantial between-trial heterogeneity pointing in the direction of potentially useful culturally adapted IMI which now need to be disentangled from the less promising approaches. PROSPERO registration number: 42020152939
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Affiliation(s)
- Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany.
| | - Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany
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17
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Kulhánek A, Lukavska K, Gabrhelík R, Novák D, Burda V, Prokop J, Holter MTS, Brendryen H. Comparing Reminders Sent via SMS Text Messaging and Email for Improving Adherence to an Electronic Health Program: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e31040. [PMID: 35302945 PMCID: PMC8976257 DOI: 10.2196/31040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/12/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background
eHealth interventions can help people change behavior (eg, quit smoking). Reminders sent via SMS text messaging or email may improve the adherence to web-based programs and increase the probability of successful behavior change; however, it is unclear whether their efficiency is affected by the modality of the communication channel.
Objective
A 2-armed randomized control trial was conducted to compare the effect of providing reminders via SMS text messaging versus email on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quit attempt.
Methods
Smokers were recruited via an internet-based advertisement. A total of 591 participants who diverted from intended use of the program (ie, failed to log on to a session) were automatically randomized to the experimental (SMS text messaging reminder, n=304) or the active comparator (email reminder, n=287) group.
Results
Unexpectedly, we found that the mode of reminder delivery did not significantly affect either the adherence, namely the number of completed program sessions, with the SMS text messaging reminder group showing a mean of 4.30 (SD 3.24) and the email reminder group showing a mean of 4.36 (SD 3.27) (t586=0.197, P=.84, and Cohen d=0.016), or the outcome, namely the quit smoking attempt rate (34.2% in the SMS text messaging group vs 31.7% in the email group; χ21=0.4, P=.52). Secondary analyses showed that age, gender, and education had significant effects on program adherence and education on the outcome. Moreover, we found a significant interaction effect between the mode of reminder delivery and gender on program adherence, suggesting that the effectiveness of SMS text message reminders might be different for females and males. However, this particular finding should be treated with care as it was based on post hoc subgroup analysis.
Conclusions
This study indicates that the modality of user reminders to log on increased neither the program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using emails instead of SMS text messaging reminders.
Trial Registration
ClinicalTrials.gov NCT03276767; https://clinicaltrials.gov/ct2/show/ NCT03276767
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Affiliation(s)
- Adam Kulhánek
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Lukavska
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Psychology, Faculty of Education, Charles University, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniel Novák
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Václav Burda
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jindřich Prokop
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Marianne T S Holter
- The Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Håvar Brendryen
- The Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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18
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Bellinger C, Foley KL, Dressler EV, Kittel C, Miller DP, Weaver KE, Sutfin EL, Petty WJ, Spangler J, Stone R, Anderson DM, Kehn H, Steenstra C, Panikkar R, Chiles C. Organizational Characteristics and Smoking Cessation Support in Community-Based Lung Cancer Screening Programs. J Am Coll Radiol 2022; 19:529-533. [PMID: 35247325 PMCID: PMC8983582 DOI: 10.1016/j.jacr.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Christina Bellinger
- Department of Pulmonology and Critical Care, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Kristie Long Foley
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P Miller
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jeffrey Petty
- Department of Thoracic Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rebecca Stone
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Heather Kehn
- Metro Minnesota Community Oncology Research Consortium
| | | | - Rajiv Panikkar
- Geisinger Cancer Institute National Cancer Institute Community Oncology Research Program
| | | | - Caroline Chiles
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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19
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Goldberg SB, Lam SU, Simonsson O, Torous J, Sun S. Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials. PLOS DIGITAL HEALTH 2022; 1. [PMID: 35224559 PMCID: PMC8881800 DOI: 10.1371/journal.pdig.0000002] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mobile phone-based interventions have been proposed as a means for reducing the burden of disease associated with mental illness. While numerous randomized controlled trials and meta-analyses have investigated this possibility, evidence remains unclear. We conducted a systematic meta-review of meta-analyses examining mobile phone-based interventions tested in randomized controlled trials. We synthesized results from 14 meta-analyses representing 145 randomized controlled trials and 47,940 participants. We identified 34 effect sizes representing unique pairings of participants, intervention, comparisons, and outcome (PICO) and graded the strength of the evidence as using umbrella review methodology. We failed to find convincing evidence of efficacy (i.e., n > 1000, p < 10-6, I 2 < 50%, absence of publication bias); publication bias was rarely assessed for the representative effect sizes. Eight effect sizes provided highly suggestive evidence (i.e., n > 1000, p < 10-6), including smartphone interventions outperforming inactive controls on measures of psychological symptoms and quality of life (ds = 0.32 to 0.47) and text message-based interventions outperforming non-specific controls and active controls for smoking cessation (ds = 0.31 and 0.19, respectively). The magnitude of effects and strength of evidence tended to diminish as comparison conditions became more rigorous (i.e., inactive to active, non-specific to specific). Four effect sizes provided suggestive evidence, 14 effect sizes provided weak evidence, and eight effect sizes were non-significant. Despite substantial heterogeneity, no moderators were identified. Adverse effects were not reported. Taken together, results support the potential of mobile phone-based interventions and highlight key directions to guide providers, policy makers, clinical trialists, and meta-analysts working in this area.
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Affiliation(s)
- Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, United States of America
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, United States of America
- * E-mail:
| | - Sin U Lam
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, United States of America
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Otto Simonsson
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, United States of America
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Shufang Sun
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- Mindfulness Center, Brown University, Providence, RI, United States of America
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20
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Struik L, Rodberg D, Sharma RH. The Behavior Change Techniques Used in Canadian Online Smoking Cessation Programs: Content Analysis. JMIR Ment Health 2022; 9:e35234. [PMID: 35230253 PMCID: PMC8924781 DOI: 10.2196/35234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Smoking rates in Canada remain unacceptably high, and cessation rates have stalled in recent years. Online cessation programs, touted for their ability to reach many different populations anytime, have shown promise in their efficacy. The Government of Canada has therefore funded provincial and national smoking cessation websites countrywide. However, little is known about the behavior change techniques (BCTs) that underpin the content of these websites, which is key to establishing the quality of the websites, as well as a way forward for evaluation. OBJECTIVE The purpose of this study, therefore, is to apply the BCTTv1 taxonomy to Canadian provincial and federal websites, and to determine which BCTs they use. METHODS A total of 12 government-funded websites across Canada were included for analysis. Using deductive content analysis and through training in applying the BCTTv1 taxonomy, the website content was coded according to the 93 BCTs across the 16 BCT categories. RESULTS Of the 16 BCT categories, 14 were present within the websites. The most widely represented BCT categories (used in all 12 websites) included goals and planning, social support, natural consequences, and regulation. Implementation of BCTs within these categories varied across the sites. CONCLUSIONS Analyzing the content of online smoking cessation websites using the BCTTv1 taxonomy is an appropriate method for identifying the behavior change content of these programs. The findings offer programmers and researchers tangible directions for prioritizing and enhancing provincial and national smoking cessation programs, and an evaluation framework to assess smoking cessation outcomes in relation to the web-based content.
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Affiliation(s)
- Laura Struik
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Danielle Rodberg
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Ramona H Sharma
- School of Social Work, University of British Columbia, Kelowna, BC, Canada
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21
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Alev K, Kütt A, Viigimaa M. Disclosing Pharmacogenetic Feedback of Caffeine via eHealth Channels, Assessment of the Methods and Effects to Behavior Change: A Pilot Study. Front Digit Health 2021; 2:567656. [PMID: 34713041 PMCID: PMC8521856 DOI: 10.3389/fdgth.2020.567656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The integration of genetic testing into eHealth applications holds great promise for the personalization of disease prevention guidelines. However, relatively little is known about the impact of eHealth applications on an individual's behavior. Aim: The aim of the pilot study was to investigate the effect of the personalized eHealth application approach to behavior change in a 1-month follow-up period on groups with previously known and unknown caffeine impacts. Method: We created a direct-to-consumer approach that includes providing relevant information and personalized reminders and goals on the digital device regarding the caffeine intake for two groups of individuals: the intervention group (IG) with the genetic raw data available and the control group (CG) to test the impact of the same content (article about caffeine metabolism) on participants without the genetic test. Study participants were all Estonians (n = 160). Results: The study suggests that eHealth applications work for short-term behavior change. Participants in the genetic IG tended to increase caffeine intake if they were informed about caffeine not being harmful. They reported feeling better physically and/or mentally after their behavioral change decision during the period of the study. Conclusions: Our pilot study revealed that eHealth applications may have a positive effect for short-term behavior change, regardless of a prior genetic test. Further studies among larger study groups are required to achieve a better understanding about behavior change of individuals in the field of personalized medicine and eHealth interventions.
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Affiliation(s)
- Kerti Alev
- Digital Health, Tallinn University of Technology (TalTech), Tallinn, Estonia
| | - Andres Kütt
- Information Technology and Communication Technologies, Information Technology Department, Tallinn University of Technology (TalTech), Tallinn, Estonia
| | - Margus Viigimaa
- North Estonia Medical Center, Tallinn University of Technology, Tallinn, Estonia
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22
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Derksen ME, Jaspers MW, van Strijp S, Fransen MP. Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study. JMIR Form Res 2021; 5:e24112. [PMID: 34346895 PMCID: PMC8374659 DOI: 10.2196/24112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/26/2020] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Background Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing.
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Affiliation(s)
- Marloes E Derksen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Monique Wm Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sander van Strijp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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23
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van Dijk W, Oosterman M, Jansen I, de Vente W, Huizink A. Stress- and smoke free pregnancy study protocol: a randomized controlled trial of a personalized eHealth intervention including heart rate variability-biofeedback to support pregnant women quit smoking via stress reduction. BMC Public Health 2021; 21:905. [PMID: 33980201 PMCID: PMC8115871 DOI: 10.1186/s12889-021-10910-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Maternal smoking and stress during pregnancy are associated with adverse health effects for women themselves and are risk factors for adverse developmental outcomes of the unborn child. Smoking and stress seem to be intertwined in various ways. First, the majority of smoking pregnant women is of lower socio-economic status, which is associated with higher levels of perceived stress. Second, smoking women often report to smoke because they feel stressed. Third, quitting smoking often increases perceived stress levels initially. Therefore, effective interventions are needed to support women with smoking cessation by reducing stress. The aim of this study is to test the effectiveness of an eHealth intervention on stress reduction and smoking cessation. METHODS/DESIGN The Stress- and Smoke Free Start of Life (SSFSL) study is a randomized controlled trial (RCT) comparing a personalized eHealth intervention with a control condition. Inclusion criteria for the women are: (1) > 18 years of age, (2) < 28 weeks pregnant at recruitment, (3) currently smoking. Consenting participants will be randomly assigned to the intervention or control group. Participants allocated to the intervention group will receive an 8-week intervention delivered on their smartphone. The application includes psycho-education on pregnancy, stress, and smoking (cessation); stress-management training consisting of Heart Rate Variability-biofeedback; and a personalized stop-smoking-plan. Participants in the control condition will be invited to visit a webpage with information on pregnancy, stress, and smoking (cessation). Study outcomes will be collected via online questionnaires, at four timepoints: pre-intervention (baseline; t0), post-intervention (8 weeks + 1 day after t0; t1), follow up at two weeks after birth (t2), and follow up at three months after birth (t3). The primary outcome measure is self-reported smoking cessation. Secondary outcomes include daily self-reported number of cigarettes smoked, perceived stress, pregnancy experience, birth outcomes, and negative affectivity scores of the baby. Moreover, the mediating effect of stress reduction on smoking cessation will be examined, and possible moderators will be tested. DISCUSSION If the eHealth intervention is effective in smoking cessation among pregnant smoking women, it can be implemented as a tool into the health care in the Netherlands. TRIAL REGISTRATION Netherlands Trial Register, ID: NL8156 . Registered on 11 November 2019.
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Affiliation(s)
- Willeke van Dijk
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Mirjam Oosterman
- Department of Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Imke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Wieke de Vente
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Huizink
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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24
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Abstract
The impact of tobacco smoking treatment is determined by its reach into the smoking population and the effectiveness of its interventions. This review evaluates the reach and effectiveness of pharmacotherapy and psychosocial interventions for smoking. Historically, the reach of smoking treatment has been low, and therefore its impact has been limited, but new reach strategies such as digital interventions and health care system changes offer great promise. Pharmacotherapy tends to be more effective than psychosocial intervention when used clinically, and newer pharmacotherapy strategies hold great promise of further enhancing effectiveness. However, new approaches are needed to advance psychosocial interventions; progress has stagnated because research and dissemination efforts have focused too narrowly on skill training despite evidence that its core content may be inconsequential and the fact that its mechanisms are either unknown or inconsistent with supporting theory. Identifying effective psychosocial content and its mechanisms of action could greatly enhance the effectiveness of counseling, digital, and web interventions.
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Affiliation(s)
- Timothy B Baker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
| | - Danielle E McCarthy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
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25
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Mahoney MC, Park E, Schlienz NJ, Duerr C, Hawk LW. Transitioning to Remote Clinic Visits in a Smoking Cessation Trial During the COVID-19 Pandemic: Mixed Methods Evaluation. JMIR Form Res 2021; 5:e25541. [PMID: 33878020 PMCID: PMC8092028 DOI: 10.2196/25541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
Background The pandemic of SARS-CoV-2, which causes COVID-19, has caused disruptions in ongoing clinical trials and is expected to accelerate interest in conducting research studies remotely. Objective A quasi-experimental, mixed methods approach was used to examine the rates of visit completion as well as the opinions and experiences of participants enrolled in an ongoing clinical trial of smoking cessation who were required to change from in-person clinic visits to remote visits using video or telephone conferencing due to the COVID-19 pandemic. Methods For quantitative comparisons, we used a quasi-experimental design, comparing a cohort of participants followed during the pandemic (n=23, COVID-19 cohort) to a comparable cohort of participants followed over a similar time period in the calendar years 2018 and 2019 (n=51, pre–COVID-19 cohort) to examine the rates of completion of scheduled visits and biospecimen collection. For the qualitative component, interviews were conducted with participants who experienced the transition from in-person to remote visits. Results Participants in the COVID-19 cohort completed an average of 83.6% of remote clinic visits (95% CI 73.1%-91.2%), which was not significantly different than the in-person completion rate of 89.8% in the pre–COVID-19 cohort. Participants in the COVID-19 cohort returned an average of 93.2% (95% CI 83.5%-98.1%) of saliva specimens for remote clinic visits completed, which was not significantly different than the in-person saliva specimen completion rate of 100% in the pre–COVID-19 cohort. Two broad themes emerged from the qualitative data: (1) the benefits of remote visits and (2) the challenges of remote counseling compared to in-person counseling. Despite limited experience with telehealth prior to this transition, most participants expressed a willingness to engage in remote visits in the future. Conclusions Even in the context of a rapid transition from in-person to remote visits necessitated by the COVID-19 pandemic, rates of visit completion and return of biospecimens remained high. Participants were generally accepting of the transition. Further research is needed to identify the optimal mix of in-person and remote visits beyond the pandemic context and to better understand how these changes may impact study outcomes. Trial Registration ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/study/NCT03262662
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Affiliation(s)
| | - Eunhee Park
- School of Nursing, University of Buffalo, Buffalo, NY, United States
| | - Nicolas J Schlienz
- Department of Psychology, University of Buffalo, Buffalo, NY, United States
| | - CeCe Duerr
- Department of Psychology, University of Buffalo, Buffalo, NY, United States
| | - Larry W Hawk
- Department of Psychology, University of Buffalo, Buffalo, NY, United States
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26
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Prutzman YM, Wiseman KP, Grady MA, Budenz A, Grenen EG, Vercammen LK, Keefe BP, Bloch MH. Using Digital Technologies to Reach Tobacco Users Who Want to Quit: Evidence From the National Cancer Institute's Smokefree.gov Initiative. Am J Prev Med 2021; 60:S172-S184. [PMID: 33663705 DOI: 10.1016/j.amepre.2020.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
The rapid growth of smartphone ownership and broadband access has created new opportunities to reach smokers with cessation information and support using digital technologies. These technologies can both complement and be integrated with traditional support modalities such as telephone quitlines and 1-on-1 clinical cessation counseling. The National Cancer Institute's Smokefree.gov Initiative provides free, evidence-based cessation support to the public through a multimodal suite of digital interventions, including several mobile-optimized websites, text messaging programs, and 2 mobile applications. In addition to digital resources directed at the general population, the Smokefree.gov Initiative includes population-specific resources targeted to adolescents, women, military veterans, Spanish speakers, older adults, and other populations. This paper describes the reach and use of the Smokefree.gov Initiative's resources over a 5-year period between 2014 and 2018, including how users interact with the program's digital content in ways that facilitate engagement with live counseling support. Use of Smokefree.gov Initiative resources has grown steadily over time; in 2018 alone, approximately 7-8 million people accessed Smokefree.gov Initiative web- and mobile-based resources. Smokefree.gov Initiative utilization data show that people take advantage of the full range of technology tools and options offered as part of the Smokefree.gov Initiative's multiplatform intervention. The Smokefree.gov Initiative experience suggests that offering different, complementary technology options to meet the needs and preferences of smokers has the potential to meaningfully expand the reach of cessation treatment.
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Affiliation(s)
- Yvonne M Prutzman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Kara P Wiseman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Meredith A Grady
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Alexandra Budenz
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | | | | | | | - Michele H Bloch
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Sherman LD, Patterson MS, Tomar A, Wigfall LT. Use of Digital Health Information for Health Information Seeking Among Men Living With Chronic Disease: Data From the Health Information National Trends Survey. Am J Mens Health 2021; 14:1557988320901377. [PMID: 31973642 PMCID: PMC6984431 DOI: 10.1177/1557988320901377] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Although diabetes education plays an important role in self-management for people living with diabetes, male health “help-seeking” lags far behind women. These gender-related “help-seeking” disparities often result in males being less engaged in their health care, which subsequently leads to poorer health outcomes among males. In this cross-sectional study, we used data from the 2017 Health Information National Trends Survey (HINTS) to identify factors that may contribute to communication inequalities between males and females. A hierarchical {linear/logistic} regression model was used to examine factors associated with online health information seeking among males living with diabetes. The results suggest that education, income, age, identifying as Hispanic, being a smoker, using a device to track progress toward a health-related goal, and using device to seek health information were all related to eHealth sum scores. Future research should consider testing applications among various at-risk groups to determine if the technology itself is becoming a barrier to eHealth.
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Affiliation(s)
- Ledric D Sherman
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Megan S Patterson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Aditi Tomar
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Lisa T Wigfall
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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28
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Camenga DR, Bernstein SL, Dziura J, Fiellin L, Krishnan-Sarin S. Feasibility of text messaging to augment brief advice and nicotine replacement therapy for smoking cessation in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:1-8. [PMID: 31373882 PMCID: PMC6995438 DOI: 10.1080/07448481.2019.1643730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/29/2019] [Accepted: 07/08/2019] [Indexed: 06/05/2023]
Abstract
To test the feasibility of a university health center-delivered smoking cessation intervention that adds a 6-week course of text messaging to brief advice and nicotine patch therapy. Participants: Young adult cigarette smokers (n = 40) from 2 universities from January 2015 to May 2016. Methods: Randomized controlled trial comparing brief advice, nicotine patch therapy and: (1) a 6-week text messaging intervention (n = 20); or (2) no text messaging (n = 20). Primary outcomes included enrollment, retention and satisfaction. Results: Forty participants enrolled (38% of those screened). Retention rates were 98% and 92.5% at 6 and 12 weeks. Of those who completed the text intervention (n = 16), 64.3% felt the texts were "helpful", however they reported desire for tailoring and concern that texts triggered smoking. Biochemically confirmed abstinence rates did not significantly differ between text and control arms. Conclusions: These feasibility data suggest that text messaging may need to be modified to better engage and motivate college-age smokers.
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Affiliation(s)
- Deepa R Camenga
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - James Dziura
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn Fiellin
- Department of Internal Medicine & Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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29
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Bond MH, Bunge EL, Leykin Y, Barrera AZ, Wickham RE, Barlow MR, Reyes S, Pineda B, Ceja AM, Cano M, Muñoz RF. Development and usability of a Spanish/English smoking cessation website: lessons learned. Mhealth 2021; 7:30. [PMID: 33898599 PMCID: PMC8063005 DOI: 10.21037/mhealth-19-255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Smoking cessation Internet interventions have been shown to be comparable in effectiveness to the nicotine patch. The aim of this study was to develop a Spanish/English smoking cessation web app using input from low-income smokers, and to evaluate modifications to the online intervention in terms of its ability to engage smokers. METHODS Three versions of a smoking cessation web app were developed and tested. Measures of engagement, such as completion of study registration, utilization of cigarette, mood, and craving trackers, and completion of follow-up assessments, were collected to determine whether changes in the website resulted in increased engagement. RESULTS The third version of the website, which featured improved look-and-feel and fewer barriers to engagement, markedly increased tracker engagement from the first two versions. However, follow-up rates remained low across all three versions. CONCLUSIONS The increase in engagement was attributed to the following modifications: A more inviting landing page with key intervention elements available immediately; an easily accessible dashboard with users' data; and tracking tools that were more user friendly. We conclude that in addition to adequate and functional elements, design principles are key factors in increasing engagement in online interventions.
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Affiliation(s)
| | | | - Yan Leykin
- i4Health at Palo Alto University, Palo Alto, CA, USA
| | | | | | - M Rose Barlow
- i4Health at Palo Alto University, Palo Alto, CA, USA
| | - Sara Reyes
- i4Health at Palo Alto University, Palo Alto, CA, USA
| | - Blanca Pineda
- i4Health at Palo Alto University, Palo Alto, CA, USA
| | | | - Monique Cano
- i4Health at Palo Alto University, Palo Alto, CA, USA
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30
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Balci S, Spanhel K, Sander L, Baumeister H. Protocol for a systematic review and meta-analysis of culturally adapted internet- and mobile-based health promotion interventions. BMJ Open 2020; 10:e037698. [PMID: 33168550 PMCID: PMC7654131 DOI: 10.1136/bmjopen-2020-037698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/10/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION High rates of immigration pose challenges for the healthcare systems of many countries to offer high-quality care to diverse populations. Advancing health interventions with incorporating the cultural background of diverse populations can be helpful to overcome this challenge. First studies suggest that culturally diverse populations might benefit from culturally adapted internet-based and mobile-based interventions (IMI) to promote health behaviours. However, the effectiveness of culturally adapted IMIs for health promotion interventions has not been evaluated systematically. Therefore, the aim of this review is to assess the effectiveness of culturally adapted IMIs regarding health promotion. Additionally, the cultural adaptation features of these interventions will be outlined. METHODS AND ANALYSIS Randomised controlled trials (RCTs) investigating the effectiveness of culturally adapted IMIs to promote health behaviours in the field of healthy eating, smoking cessation, alcohol consumption, physical activity and sexual health behaviour will be identified via a systematic search of the databases MEDLINE, Embase, PsycINFO, CENTRAL. The preliminary search has been conducted on the 26 August 2019 and will be updated in the process. Data will be pooled meta-analytically in case of at least three included studies reporting on the same outcome. Moreover, a narrative synthesis of the included studies will be conducted. The risk of bias will be assessed using the Cochrane Collaboration's tool for the Quality Assessment of RCTs V. 2.0. Publication bias will be assessed using funnel plots. ETHICS AND DISSEMINATION Ethical approval is not required for this study. The results of this study will be published in a peer-reviewed international journal. PROSPERO REGISTRATION NUMBER PROSPERO; CRD42020152939.
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Affiliation(s)
- Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
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31
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Wattanapisit A, Tuangratananon T, Wattanapisit S. Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review. BMC FAMILY PRACTICE 2020; 21:229. [PMID: 33158430 PMCID: PMC7648312 DOI: 10.1186/s12875-020-01304-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/29/2020] [Indexed: 02/09/2023]
Abstract
Background Physical activity (PA) counselling is an effective approach to promote PA in primary health care (PHC). Barriers to PA counselling in PHC include time constraints, lack of knowledge and skills of providers, and systemic barriers. Using electronic health (eHealth) has the potential to promote PA. This scoping review aimed to identify usability and utility of eHealth for tailored PA counselling introduced in PHC settings. Methods A scoping review included primary research articles. The authors systematically searched six databases (Cochrane Library, CINAHL Complete, Embase, PubMed, Scopus and Web of Science) from the inception of the databases. The search terms consisted of three search components: intervention (PA counselling), platform (eHealth), and setting (PHC). Additional articles were included through reference lists. The inclusion criteria were research or original articles with any study designs in adult participants. Results Of 2501 articles after duplicate removal, 2471 articles were excluded based on the title and abstract screening and full text review. A total of 30 articles were included for synthesis. The eHealth tools had a wide range of counselling domains as a stand-alone PA domain and multiple health behaviours. The included articles presented mixed findings of usability and utility of eHealth for PA counselling among patients and providers in PHC settings. Technical problems and the complexity of the programmes were highlighted as barriers to usability. The majority of articles reported effective utility, however, several articles stated unfavourable outcomes. Conclusions eHealth has the potential to support PA counselling in PHC. Facilitators and barriers to eHealth usability should be considered and adapted to particular settings and contexts. The utility of eHealth for promoting PA among patients should be based on the pragmatic basis to optimise resources. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01304-9.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand. .,Walailak University Hospital, Thasala, Nakhon Si Thammarat, Thailand.
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Shah A, Chaiton M, Baliunas D, Schwartz R. Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e16255. [PMID: 33074158 PMCID: PMC7605982 DOI: 10.2196/16255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
Background The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. Objective The aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups. Methods Literature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group. Results A total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I2=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I2=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I2=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I2=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P<.001), and 6-month (P=.02) follow-ups but not at 12-month follow-up (P=.25). Conclusions The results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced rates of dropout attrition at 1-, 3-, 6-, or 12-month follow-ups. Significant differences between studies that include untailored active and passive control groups suggest that the role of tailoring may be more prominent when studies include a passive control group. These findings may be because of variability in the presence of additional features, the definition of smokers used, and the duration of smoking abstinence measured. Future studies should incorporate active web-based controls, compare the impact of different tailoring strategies, and include populations outside of the Western countries.
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Affiliation(s)
- Amika Shah
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dolly Baliunas
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Robert Schwartz
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Thilsing T, Sonderlund AL, Sondergaard J, Svensson NH, Christensen JR, Thomsen JL, Hvidt NC, Larsen LB. Changes in Health-Risk Behavior, Body Mass Index, Mental Well-Being, and Risk Status Following Participation in a Stepwise Web-Based and Face-to-Face Intervention for Prevention of Lifestyle-Related Diseases: Nonrandomized Follow-Up Cohort Study. JMIR Public Health Surveill 2020; 6:e16083. [PMID: 32673269 PMCID: PMC7380905 DOI: 10.2196/16083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/10/2020] [Accepted: 04/12/2020] [Indexed: 01/18/2023] Open
Abstract
Background Recent evidence suggests the effectiveness of stepwise, targeted approaches for the prevention of lifestyle-related diseases with combinations of web-based and face-to-face interventions showing promising results. Objective This paper reports on 1-year changes in health-risk behaviors, BMI, self-rated health, mental well-being, and risk of disease at 1-year follow-up after participation in a stepwise intervention that targeted persons at high risk of disease and persons with health-risk behavior. To this end, we distinguish between participants who took up the full intervention (web-based plus face-to-face) and those who received only the web-based intervention. Methods The Early Detection and Prevention (Danish acronym: TOF) pilot study was conducted as a nonrandomized, 1-year follow-up intervention study in two municipalities in the Region of Southern Denmark. A total of 9400 citizens born between 1957 and 1986 (aged 29 to 60 years) were randomly sampled from participating general practitioner (GP) patient-list systems and were invited to take part in the study. Participants were subsequently stratified into risk groups based on their responses to a questionnaire on health-risk behavior and data from their GP’s electronic patient record (EPR) system. All participants received a digital personal health profile with individualized information on current health-risk behavior and targeted advice on relevant health-risk behavior changes. In addition, patients at high risk of disease, as indicated by their digital health profile, were offered a targeted intervention at their GP. Patients who were not deemed at high risk of disease but who exhibited health-risk behaviors were offered a targeted intervention at their municipal health center (MHC). At 1-year follow-up, health-risk behaviors, self-rated health, BMI, and mental well-being were reassessed by questionnaire, and current information on diagnoses and medical treatment was retrieved from the EPRs. Results Of 598 patients at high risk of disease or with health-risk behavior, 135 took up the targeted intervention at their GP or MHC and 463 received the personal health profile only. From baseline to 1-year follow-up, the number of patients with unhealthy eating habits decreased, mean mental well-being increased, and smoking prevalence decreased in patients who had received the digital personal health profile alone. Among patients who took up the targeted intervention, unhealthy eating habits and sedentary lifestyles decreased and significant reductions in mean BMI were observed. At 1-year follow up, no health-risk behaviors were detected among 17.4% of patients who at baseline had exhibited health-risk behaviors or high risk of disease. Conclusions A stepwise targeted preventive approach using web-based and face-to-face elements may lead to favorable lifestyle changes. Specifically, a web-based approach may improve smoking and eating habits and mental well-being, whereas supplementary face-to-face interventions may be necessary to improve exercise habits and BMI. Trial Registration ClinicalTrials.gov NCT02797392; https://clinicaltrials.gov/ct2/show/NCT02797392 International Registered Report Identifier (IRRID) RR2-10.1186/s12875-018-0820-8
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Affiliation(s)
- Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anders Larrabee Sonderlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Sondergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Nanna Herning Svensson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Janus Laust Thomsen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Dickman Portz J, Ford K, Bekelman DB, Boxer RS, Kutner JS, Czaja S, Elsbernd K, Bull S. "We're Taking Something So Human and Trying to Digitize": Provider Recommendations for mHealth in Palliative Care. J Palliat Med 2019; 23:240-247. [PMID: 31526220 DOI: 10.1089/jpm.2019.0216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Mobile health (mHealth) is a promising tool for improving health outcomes. However, the benefits of using mHealth in palliative care are under studied. Objective: As a first step to designing meaningful palliative care-specific mobile applications, this research explored provider perspectives regarding the utility of mHealth in palliative care. Design: A qualitative phenomenological study with semistructured interviews. Setting/Subjects: Providers from multiple disciplines working in palliative care settings at an academic medical center. Results: Thematic analysis resulted in five provider recommendations regarding the utility and design of palliative care-specific mHealth, including (i) thoughtfulness to language, context, and delivery when assessing palliative care needs; (ii) include tools for prognosis and advance care planning; (iii) tailor health and quality-of-life goals; (iv) emphasize supports for family and caregivers; and (v) consider technology abilities of older adults. Conclusions: Palliative care providers are enthusiastic about the use of mHealth to improve care coordination, facilitate communication, enhance symptom monitoring, and improve patient-family support. However, providers have reservations about mobile functionality and depersonalized assessment and care. Providers stress the utility of mHealth to facilitate palliative care rather than replace important multidisciplinary services.
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Affiliation(s)
- Jennifer Dickman Portz
- Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado.,mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kelsey Ford
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David B Bekelman
- Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado.,Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, Colorado
| | - Rebecca S Boxer
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Jean S Kutner
- Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado
| | - Sara Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - Kira Elsbernd
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sheana Bull
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Huckvale K, Venkatesh S, Christensen H. Toward clinical digital phenotyping: a timely opportunity to consider purpose, quality, and safety. NPJ Digit Med 2019; 2:88. [PMID: 31508498 PMCID: PMC6731256 DOI: 10.1038/s41746-019-0166-1] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023] Open
Abstract
The use of data generated passively by personal electronic devices, such as smartphones, to measure human function in health and disease has generated significant research interest. Particularly in psychiatry, objective, continuous quantitation using patients' own devices may result in clinically useful markers that can be used to refine diagnostic processes, tailor treatment choices, improve condition monitoring for actionable outcomes, such as early signs of relapse, and develop new intervention models. If a principal goal for digital phenotyping is clinical improvement, research needs to attend now to factors that will help or hinder future clinical adoption. We identify four opportunities for research directed toward this goal: exploring intermediate outcomes and underlying disease mechanisms; focusing on purposes that are likely to be used in clinical practice; anticipating quality and safety barriers to adoption; and exploring the potential for digital personalized medicine arising from the integration of digital phenotyping and digital interventions. Clinical relevance also means explicitly addressing consumer needs, preferences, and acceptability as the ultimate users of digital phenotyping interventions. There is a risk that, without such considerations, the potential benefits of digital phenotyping are delayed or not realized because approaches that are feasible for application in healthcare, and the evidence required to support clinical commissioning, are not developed. Practical steps to accelerate this research agenda include the further development of digital phenotyping technology platforms focusing on scalability and equity, establishing shared data repositories and common data standards, and fostering multidisciplinary collaborations between clinical stakeholders (including patients), computer scientists, and researchers.
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Affiliation(s)
- Kit Huckvale
- Black Dog Institute, UNSW Sydney, Sydney, NSW Australia
| | | | - Helen Christensen
- Black Dog Institute, UNSW Sydney, Sydney, NSW Australia
- Mindgardens Neuroscience Network, Sydney, NSW Australia
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Groenhof TKJ, Asselbergs FW, Groenwold RHH, Grobbee DE, Visseren FLJ, Bots ML. The effect of computerized decision support systems on cardiovascular risk factors: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2019; 19:108. [PMID: 31182084 PMCID: PMC6558725 DOI: 10.1186/s12911-019-0824-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background Cardiovascular risk management (CVRM) is notoriously difficult because of multi-morbidity and the different phenotypes and severities of cardiovascular disease. Computerized decision support systems (CDSS) enable the clinician to integrate the latest scientific evidence and patient information into tailored strategies. The effect on cardiovascular risk factor management is yet to be confirmed. Methods We performed a systematic review and meta-analysis evaluating the effects of CDSS on CVRM, defined as the change in absolute values and attainment of treatment goals of systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-c) and HbA1c. Also, CDSS characteristics related to more effective CVRM were identified. Eligible articles were methodologically appraised using the Cochrane risk of bias tool. We calculated mean differences, relative risks, and if appropriate (I2 < 70%), pooled the results using a random-effects model. Results Of the 14,335 studies identified, 22 were included. Four studies reported on SBP, 3 on LDL-c, 10 on CVRM in patients with type II diabetes and 5 on guideline adherence. The CDSSs varied considerably in technical performance and content. Heterogeneity of results was such that quantitative pooling was often not appropriate. Among CVRM patients, the results tended towards a beneficial effect of CDSS, but only LDL-c target attainment in diabetes patients reached statistical significance. Prompting, integration into the electronical health record, patient empowerment, and medication support were related to more effective CVRM. Conclusion We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment. Some features of CDSS seem more promising than others. However, the variability in CDSS characteristics and heterogeneity of the results – emphasizing the immaturity of this research area - limit stronger conclusions. Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and patient empowerment. Electronic supplementary material The online version of this article (10.1186/s12911-019-0824-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Katrien J Groenhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Rolf H H Groenwold
- Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK.,Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
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